Who Do I Believe?

If you've read my previous post here in the Insurance Forum, you will know that I'm very frustrated with the approval process with my insurance company.  First of all, it is VERY difficult to get someone at the insurance company to return a call (the approval process for bariatric surgery goes through a special department where no one actually answers the phone - everything is done by voicemail).  For over four weeks now I have been receiving conflicting information from the insurance company and the surgeon's office.  When I do get a response from the insurance company it is always "we haven't received anything, have your surgeon fax us at.....".  When I talk to the surgeon's office I am told "we submitted everything several weeks ago and have followed up and they have it.  It is pending and being reviewed.  They have 90 days to respond and they will not acknowledge receipt due to liability issues"  It has been over 4 weeks.  I was given the impression that my insurance was one that responded very quickly with approvals/denials (per the nurse in the surgeon's office).  So, who am I supposed to believe??  Someone is obviously giving me bad information or lying.  I am about ready to just forget having surgery.  The whole process from getting my psych eval received at the surgeon's office to scheduling a sleep study has been a nightmare and very stressful.  I really just don't see the point in planning on surgery anymore....

While I understand this is a frustrating process, you are taking a rather defeatist approach.  You don't know what is going on, so you are just going to give up?  Why not, at least, let your surgeon's office handle it.  What's the worst that can happen - you wait the 90 days they tell you (of which you've already waited at least 30), they follow up, and realize that the paperwork never was actually received.  You are in no worse of a situation than you are right now.  

Or, you can continue to call the insurance company each day, tell them you know they have received the paperwork, and you want that confirmed by a supervisor.  If you are having problems with them responding to you, why don't you call your state's Department of Insurance to file a complaint, or find out what your rights are?

Yes, this is a nightmare.  Yes, it is frustrating.  Yes, it is increasing your blood pressure.  Yes, it is not fair.  But, let someone else do this job - your job is to focus on you.  

Thanks for the reality check, noftessa.  I definitely posted this in frustration.  I really did feel like giving up at that moment but I most certainly did not.  Just needed to vent. 

I did keep calling the insurance company and I did let them know I would file a complaint with the insurance commissioner if I did not receive a response to my inquiries.  I was immediately given the name and direct number for a supervisor.  Since then, I have received callbacks within about 24hrs of my messages.  I also continued to follow up with my surgeon's office once a week.  I finally got some kind of progress on Friday.  My insurance coordinator and I had a great phone call and I received all of the items in my file that was sent to the insurance company.  He had refaxed everything on Thursday and I faxed it again on Friday.  The insurance called me today and confirmed they had received everything, it was assigned to a nurse and being reviewed, and I should have an approval/denial in the next day or two. 

I really would not suggest someone give up or just wait and see.  Being proactive saved me two months of waiting to find out that nothing was received in the right place. 

I am so glad you followed up.  That is awesome news!  Good for you!

I also would not *normally* suggest someone wait and see.  But, given that choice or the choice of giving up, what does waiting and see cost?  I agree being proactive is the best way to go - but sometimes, one just doesn't have the energy to invest in that.  

I'm glad you found the energy.  Yay you!