Encouragement for Barb,, and other Insurance Memoirs
Hi Barb:
Here's to a speedy approval.........
Yes, do call your Insurance company just to make sure that they have received all the documentation that is required of you. You will not risk being categorized as a pesky policy holder and getting a big red x for denial because you called to make sure all was there. This is done everyday by hospitals, doctor's offices, labs...etc... to make sure all documents have been received. It is just good follow-up. Just think 3 weeks from now when you are sitting there waiting for your approval or at least a word from someone about something and they tell you like they told me that half of the incoming fax papers were missing so they didn't get all they needed from the Hosp. so instead of them letting me or anyone else know they just send a letter of denial saying denied due to medically not necessary, and of course you receive this letter on a Friday afternoon when you can't reach anyone and you have to wait all weekend crying and not getting out of bed because you are devastated and do not understand what on earth that could possibly mean. So on Monday morning when you do talk to a person at the Insurance Company they tell you "Oh, we only received half of the facsimile, please refax that to us so that we can get it in our system." Then when it is re-faxed it has to sit in a holding tank for 2 or 3 days before it is retrieved... After the reviewer gets to look at it again when they get back from vacation and they decided well yes it is medically necessary and they send your approval letter out 10 days after that, which by the way even though they verbally approved it over the phone to your surgeon's office they can't actually give you a date because they need the documentation in their hands (which I don't blame them one bit) by that time you have aged 10 years over night and all could have been avoided in the very beginning with a call to make sure they have received everything they needed.
That is what is so great about a support board, we can learn so much from each others experiences, trials and errors. Even though I had read a thousand times that I had to take control of my own situation that nobody was going to look after me but me, I had let myself become so timid that I actually thought I was bothering someone or I was risking being viewed as pushy and pesky and that surely I would be denied just so that someone over me could.
Everyone here on the board has had from what I've read a different experience with the approval process, some speedy (1 day) some slow (1 month) some ridicoulsly slow (1 year) some no approval at all, how unfair is that.... But I have come to realize that isn't that true with everything in life? With that being said though we can never give up. Fight for what is yours, the prize on the other side is so worth the fight.
Barbara, you have done so great... We are here for you.... Oh and by the way you have chosen the best surgeon in the world....:-)
Such a sweetheart,and such an inspiration, thank you so much. I have called the insurance company. I guess you should say take that ole bull by the horns and let it rip. Oh how precious are my friends here ,each and everyone. Just as I've listens, but I still have problems standing behind the curtains. It is a habit I need to break or should I say a shell that needs to be opened. I've always been great with people when it is for other, except for myself, then is back into the closet. Thank you for putting it out there. I will call again,
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Barb, I am so proud of you. Taking the bull by the horns and letting it rip is a great start in this journey that you have chosen to reclaim your life and self esteem. I know you are so giving and loving to others, it shows in all your post. And trust me that will not change when you get your self esteem back you will be able to do for everyone else and you too...
We should never equate self esteem with selfishness, egotistic or narcissistic.
Well it goes to show you even if your not the one to ask the question you might learn something. After Julie's responce I got concerned, I didn't want to rock the boat, I was told my insurance was filed last tuesday 01/22/08, just sit back and will have a answer in a couple weeks. Well I took your advise and phoned my insurance, they stated they had nothing from the hospital. So I called my surgeon's insurance lady and left a message stating this. Will see what the responce will be????? I hope the girl at BC/BS just didn't look in the right place but how will I know?
Bob,
Yes, you have done the right thing. This is in no way is a negative reflection on any of our Weight Loss Surgery Centers, our WLS Insurance coordinators etc... It is just being Pro Active in our Health Care. That is a positive thing. I have never worked in a hospitals Insurance Coordinator position but I can only imagine what a stressful possibly underpaid position that might be. I just view it as "we" (meaning patient, surgeon, nurses, administrative staff, etc.. etc..) partner together and cross every I and dot every T, that it is a win win for everyone involved.
Bob, I have BC/BS. From my experience with the process everything that comes in rather it be via snail mail, fax, e-mail, or a phone call is all logged in to the computer system. So each time when you speak to a BC/BS representative everything is in the log and the ones I have spoken to in the past are more than happy to read every line off to me with dates and times and they were always very nice to me. So, if they tell you no, we show no record of receiving, I would ask the surgery center what method they used to send the documents (mail or fax) so that you can call the insurance company back and say okay if you do not have my submitted documents for insurance approval, how can I remedy this today for you to receive them in your system? They will tell you..
Bob, also, BC/BS has a website and login for their members to log on to and it shows the member the status of their request... Have you been able to access the online data?
Let me know if there is something I can help you with. I don't know how successful I would be, but I would be happy to try. By the way, you have chosen the best surgeon in the world too!!!! :-) LOL
Julie is EXACTLY on the mark with this. Check out my blog and see what I had to do to get CIGNA to finally give the approval. But it was worth it all. FYI...My wife will argue about who's the best RNY surgeon, she swears by Dr. Dyer at Centennial, but for DS there is only one...the best...Dr. Albert Spaw at Baptist.
I'm loving my DS.
Doug
Duodenal Switch= Definite SOLUTION for Morbid Obesity!
HW:340 /SW:297 /CW:232 /GW:190 http://forgodsolovedme.com/
Thanks Barb, great info I'm not the type to burry my head in the sand. The blame game doesn't get you anything but added stress! But nothing wrong with being pro-active. I might take you up on the BC/BS web site I'll try first if I get stuck I'll see what you can do. Thanks again. and Thanks Doug for your input much appreciated.
Hi Doug,
I will have to check out your blog and read about your experiences. Sounds interesting...
I agree with you and your wife, All of our surgeons are the best...We always joke about that at certain get togethers because most of us each have different surgeons around town. But isn't it wonderful we are each able to say our surgeon is the best. If we weren't saying that, I would be scared.
I went to every seminar at every hospital 3 times each or more. My family laughed at me and called me a "Professional Seminar Goer". And I guess they were right. I went to so many that I could have probably led the seminar. LOL.... But my story is just like everyone else's. When I listened to Dr. Richards there was something different about him and I knew he was the one for me. Now don't get me wrong, he certainly has his ways about him that may be a different personality from say some other Surgeons like for instance when we talk he sticks straight to the facts and what is at hand and there is little if no small talk and I really don't look for him to call me next week and ask me to go play 18 holes of golf with him but I do know that he was the right surgeon for me and I think he hung the moon.
Looking forward to reading your story........
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