Anyone Had This Experience?
Greetings: Well, we heard from the "Surgical Counsel" and the consensus opinion is, they don't want to take on another surgeons patient. They advised going back to the Bariatric Surgeon. I made contact with the Health Benefits section for our retirement group to see if they would induce the HMO to pay for the surgery and they directed me to FAX them a letter giving them the total story up to this date. Now I wait to hear from them. In the meantime, the wife is still miserable. If one of those hernias goes into "strangulation", the HMO will be paying for emergency surgery and I'll bet it will be a lot more than the price of a simple hernia repair. 
Greetings Group: Well, after not hearing from the HMO for almost a week, I called their "customer service" number again. Got a different rep this time and he advised that I would have to re-contact the PCP for "outside the system" physician service. Did that and so far....................not a word. Monday, I'm going to our Medical Clinic for a "Face to Face" with the Patient Advocate to see if they can't light a fire under the Primary Care Physician's tail. Sure did make for a not so "Thankfull" Thanksgiving.
Greetings Group!
Let me begin by saying "Thank You" to all who posted ideas, encouragement and suggestions.
Today, I got to dance "The Happy Dance". I met with the Patient Advocate at our Medical Clinic on Monday as I had said I was going to do. I related what had occurred and what I had tried and she sat there for a moment with a "lost" look on her face. She then replied, "Well, you have done everything that I would have done, and I don't see why you haven't received approval for a referral". With that, she picked up her phone, placed a call to the person responsible for the Referral Section and after speaking to the party, she hung up and said she was going to meet face to face with the person. I headed on home still wondering which way to go next. I had an appointment to see my PCP on Wednesday and after completing that visit, I stopped in at the Advocates Office. I asked the Advocate how the situation was proceeding and she looked surprised and said, "Didn't they call you?" I said, no, and with that, she made a couple of quick entries into her computer, walked over to the printer and brought back the printout which indicated "Approval for Surgery and 3 followup visits"! Needless to say, I was on Cloud Nine! My wife contacted her Bariatric Surgeon and the office advised her that they "had just received the approval and were in the process of scheduling the required surgery". Prayers answered and Joy in my heart.
Thank you all once again.
Let me begin by saying "Thank You" to all who posted ideas, encouragement and suggestions.
Today, I got to dance "The Happy Dance". I met with the Patient Advocate at our Medical Clinic on Monday as I had said I was going to do. I related what had occurred and what I had tried and she sat there for a moment with a "lost" look on her face. She then replied, "Well, you have done everything that I would have done, and I don't see why you haven't received approval for a referral". With that, she picked up her phone, placed a call to the person responsible for the Referral Section and after speaking to the party, she hung up and said she was going to meet face to face with the person. I headed on home still wondering which way to go next. I had an appointment to see my PCP on Wednesday and after completing that visit, I stopped in at the Advocates Office. I asked the Advocate how the situation was proceeding and she looked surprised and said, "Didn't they call you?" I said, no, and with that, she made a couple of quick entries into her computer, walked over to the printer and brought back the printout which indicated "Approval for Surgery and 3 followup visits"! Needless to say, I was on Cloud Nine! My wife contacted her Bariatric Surgeon and the office advised her that they "had just received the approval and were in the process of scheduling the required surgery". Prayers answered and Joy in my heart.
Thank you all once again.
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