DENIED !!!

Hi everyone ...

Well i only got the bariatric surgeon to submit the information to the insurance company this monday and I got the response from Blue cross today in the mail ... stamped DENIED.
Well not really stamped but it may as well be ..Apparently it is denied because the surgeons department is not considered a Bariatric Specialty Center by the NewYork Department of Health.. I think there are two other places that are listed as bariatric specialty centers here in Rochester New York so  I will be making a few phone calls on Monday about who I need to see toget this approved for somewhere else .. this should be fun ... NOT  ;
Sorry just needed to vent in here because I got a phone call at the end of December from my bariatric surgeons office and they told me that there may be a problem with the insurance because the person that i saw for the psyche eval was not a psychologist .. i told them that the insurance company had given me the name of that person to do the evaluation and they were aware of the reason for going to see that person.. i told the person on the phone that i wanted them to submit it as it was with that person because of that reason. ... well i waited a few months before I called the surgeons office to find out what happened with the approval and found out that she didn't have anything except the dieticians paperwork and i told this woman about the previous phone call from their office in December .. She said that she would look into it and I gave her my phone number and asked her to keep me informed of the situation ...Well in the letter that was dated on Thursday march 11th the insurance company said that my doctor's office was informed verbally of the denial.   What I would love to know is why didn't the surgeons office call me on thursday and tell me about this??"???   They are so incompetent at the office that they don't inform people of the denials from the insurance company ... Doctors are only as good as the support staff of their office .. because if they are incompetent .. they don't get any patients ...


OK .. I think I am done now ...maybe ... this just ****** me off about this .. i have been waiting for 3 months and for nothing ....

Thanks for listening (reading) 

Jenn ....

Jenn so sorry about your denial.  Check out the surgeons that are listed as centers of excellence.  Once you find another surgeon, resubmit and be the squeeky wheel that you need to be to get your surgery.  It sounds like the insurance company based your denial on the surgeon instead of not meeting wls criteria.  Take a deep breath, dig in your heels and do not take NO for an answer. 

sorry about the denial. but honestly, i would rather find out now that the surgeon isn't among the best you could have doing this surgery.  hope u will get another answer soon from your soon to be surgeon. good luck. vick

I'm in the Rochester NY area as well, have you tried Highland Hospital with Dr. O'Malley?  That's where I'm going.  I'm worried about getting approved as well, I have Healthy Blue.

Actually I have BlueChoice Options .. I have been calling the insurance company for most of the good information that i have gotten so I am thinking  I am just going to call them and see if they had looked at the rest of the paperwork to see everything else is in order and find out which of them I should call to get the surgery done at ...
I figure that I may as well go to the source to get the information ...
I know that I can contact the other two people ( the dietician and the psyche eval) that I have seen to have the information submitted to the new surgeons office ..

Believe me I have not given up on this at all .. I am just mad at the surgeons office for being so awful about this.. the incompetence of the staff and such ..

Hey Jen... MAN I can almost feel your frustration and dismay! I would be HOT too.

Now, remember this tho.. sometimes things happen for a reason. I am sure this surgeon would not have been the best for you if they are not able to qualify as an approved center. It may be a big blessing in disguise that you were denied for this provider. To be an approved center, they have to have extremely low complication rates and extremely high success rates. So I am thinking, it is best you do have a different surgeon. (Have to wonder why they are not approved).

Try to take a few deep breaths and know that it is a delay, but probably for your best intrest. Follow up with your insurance company on the other things you mentioned above. If the new surgeons office will accept the other tests / pre-op req., it may not take long.

I am sorry you went through all of this, just to be back at what must seem like square one, but hang in there... you will likely be in far more capable hands and fare much better during and after surgery.

Hugs to you.

Jen,
So sorry about the bad news and especially the incompetence of that office staff. I have BlueOptions NC and my surgeon/center were designated as Center of Excellence, so as long as I met all the criteria and passed all the required tests, my approval was "a done deal". The staff told me I would be approved with no problem as soon as they submitted the paperwork and they were right. hopefully you quickly get lined up with one of these in your area and get moving right along to approval and a date! Keep us posted on your progress.

Rhonda