Did you have to use an attorney to get your surgery approved??
I appreciate ALL your valuable feedback. I have to admit...I was a little "miffed" at first by your response. But that is because this whole process has been a roller coaster. I do not feel my surgeons office is willing to "fight" for me. I was looking for some support and some encouragement. I do think it is sad, for anyone, to not know their own policy. You should NEVER EVER rely on someone else to get the info YOU need. I am frustrated that the info I get from my insurance is not the correct info. And yes...the surgeons office is more knowledgeable because that is their "specialty". But that doesn't negate the fact that the insurance reps are misquoting my benefits. I am going to appeal based on ASMBS guidelines and I have met all other criteria. I haven't given up yet 
. And please...keep posting. The knowledge and experience you have is valuable. I wouldn't have gotten this far without you "veterans". LOL. This board is ore valuable then the nut class I had and even the seminar. Thank you and be blessed!
. And please...keep posting. The knowledge and experience you have is valuable. I wouldn't have gotten this far without you "veterans". LOL. This board is ore valuable then the nut class I had and even the seminar. Thank you and be blessed!
You can go a head and get a lawyer but like the other poster said it is going to cost you a fortune and I dont think it is going to get you anywhere. Basing anything on the ASMBS has nothing to do with anything - they are just guidelines but nothing to do with your coverage. there are tons of people that meet the criteria but still get rejected for numerous reasons and you listed in your first post if that is true - something you cant get around - if you dont have 3 years of documented weight histories and that is what your insurance requires = you have to wait the 3 years and get the weigh ins with your doctors. I gave you some examples of how some post ops get around it but if you dont have any of that, you are going to have to get it the right way.
To me, the surgeons understand the medical terminologies and what the insurance companies want more than I understand, so I would rather they call and ask the proper questions rather than me calling and not asking the right questions and getting stuck short.
If you feel your surgeon isnt doing enough for you, you have the option of finding another surgeon that you trust but that is part of finding a surgeon is for them to do alot of the legwork for you. at my surgeons office, I dont have to do a thing - I show up for my appointments, they give me a list of tests, labs and consults at other doctors I have to go for and they do the rest. They call the other doctors and tell them what letters need to written and what needs to be in them and they file all the paperwork and find out all the requirements and do whatever is needed and I mean whatever possibly can be done. If it is impossible, then it cant be done.
But, maybe you just need a different surgeon or you just need to take the 3 years to get the requirements your insurance wants. I know it isnt what you want to hear but just because others and even the majority of other dont need what you need, they dont have your insurance and like I said earler - the ASMBS has absolutely nothing to do with it.
To me, the surgeons understand the medical terminologies and what the insurance companies want more than I understand, so I would rather they call and ask the proper questions rather than me calling and not asking the right questions and getting stuck short.
If you feel your surgeon isnt doing enough for you, you have the option of finding another surgeon that you trust but that is part of finding a surgeon is for them to do alot of the legwork for you. at my surgeons office, I dont have to do a thing - I show up for my appointments, they give me a list of tests, labs and consults at other doctors I have to go for and they do the rest. They call the other doctors and tell them what letters need to written and what needs to be in them and they file all the paperwork and find out all the requirements and do whatever is needed and I mean whatever possibly can be done. If it is impossible, then it cant be done.
But, maybe you just need a different surgeon or you just need to take the 3 years to get the requirements your insurance wants. I know it isnt what you want to hear but just because others and even the majority of other dont need what you need, they dont have your insurance and like I said earler - the ASMBS has absolutely nothing to do with it.
Most Active
Recent Topics