Another hurdle to jump!

So I called my insurance company yesterday and after all this hurdle jumping to ensure that there was no way for my insurance company to deny...i got denied and I am FUMING!!! The reason, you might ask...my surgeon's office forgot to submit some of the documentation!!! Now, making matters worse, they want me to jump through more hoops because they are now afraid to "waste" one of my (I believe I get 2) appeals...they want me to do another 3-6 months with the nutritionist (even though I already have 6 months of doctor supervised diet but they now don't want to take the chance because it is not completely consecutive...i moved after 5 months and it took me a couple of months to find a doctor for the last month of doctor supervised). I am so tempted to take my business elsewhere as every time I think I am done, they come up with something else! I am so frustrated at this point and just don't know what to do! Thanks for letting me vent...I'll get over and through it! Christine

Christine what ever you do DONT GIVE UP!!!!!!!! Your in my prayers keep fighting hun.

Thanks! I plan on fighting it...just not sure if I should stick with this surgical group or find another. I really like the doctor but am not at all happy about the treatment that my case has received from the office staff.

Christine, I too had to jump through many a hurdle(you are more then welcome to read my profile). I can't believe they want to extend your sup. diet out! So this is the surgeon's office directing this? Have you talked to your insurance on this matter? I wish you the best of luck. It is very tiring and trying to the soul, but you will perservere! Move mountains if you have to! Kirsten

It's crazy that now that they messed up, they want to be OVER cautious so I don't get denied on appeal. The insurance company said that because it went to the medical director incomplete, the only route is appeal or a peer to peer which is I think similar to an appeal. The worst thing is that if they had just mentioned this back in November when I started the process, I could have had a whole additional 5 months done. I'll keep pushing...I just need to regroup and get myself back together. Thanks for the well-wishes! Christine

I started my approval process in August with the first visit to my pcm, and didn't get approved until the end of February. I said about the same thing, but I was all "If I'd have known it was going to take this long I would have joined Weigh****chers(again) or something just to kick start me!" Never give up! never surrender!, I think they said that on that goofy movie "Galaxy Quest". Sorry! I have kids! OT: I just looked at your profile...It's adorable, in a royal sort of way! I didn't know Jessica Simpson remade YOU Take My Breath Away! I like it, loved the original too! Kirsten

Oh, Honey, don't you dare give up....keep fighting this with everything you have. Fight for your life, gf. You are in my thoughts and prayers that you will get your approval real soon... Hugs, Betsy

I sure will fight! Thanks for the prayers and encouragement Bets! Christine

Hey Christine, You are the boss here. It's YOUR insurance that will be paying them. They are erring on the side of caution, but if you don't want to play that game, please just tell them so. Tell them you are willing to "waste" one of your appeals, if they are sure the only reason you were denied was their error, not yours. If there is something they are not telling you, or some other reason for this decision, they need to share it with you. As it stands, that is just lame. Plus whoever you talked to, if it wasn't the surgeon, talk to him about it. I'm sure he'll get the ball rolling back in your direction. Good luck Carole

Thanks for the advice Carole! It never even occurred to me to speak with Dr S. Do you really think that he may be able to do something else? I believe that the diet thing is the only thing...I spoke with my insurance company directly and that's what they told me. Who knows...