Am I approved or being stalled????

Despite being told that the coordinator was filing the paper work as "stat" to get the insurance to move faster and that she would now "stay on top of it"....I once again noticed a week passing with out a call.  So, I called the insurance company to see if they had even received the request for surgery.  And was told yes the received it, it was processed, and it was approved. 

The letter arrived today.  No where on the letter does it say "APPROVED".  It says they do cover the particular procedure.  But that does not guarantee payment for said procedure.  It lists a host of reasons why they might not.  Things like payment of premium and eligibility at time of service, I can understand.  But it also lists exclusions,  limitations, and preexisting conditions.  What does that mean.....they can exclude just me even though the procedure is covered???  They can say nope my obesity was a preexisting condition so we will not cover me????

It goes on to say some procedures require precertification.  Isn't that what we were suppose to be requesting?


I am so confused.  Am I approved or not?????

Call the doc's office and ask them!  I don't know if you read it but that happened to me (again it was a LONG time ago) and someone told me on the phone but I wasn't and had to wait for some special thing to be approved.  It certainly sounds good but of course you never know until you hear it from your doc.

Like I told Suzy, I've got everything crossed that I can cross.  I just know it has to happen and I can't wait for your frustration to end.  Bless your heart.....you've been through ENOUGH!
hugs, Y

Oh, I called and got voice mail AGAIN....yes it is starting to seem lol funny to me too.....I wonder how long I will have to wait this time for a returned call....so I went a head and called another surgeon....will meet with them next week I think....I guess I need to call first thing in the morning and ask for my reccords....

I'd go park my butt at the office until I got an answer.  Won't they make you start all over???  I mean you got a letter and it might be just as simple as the office saying "Oh yea, you're approved, let's schedule the date".  How much can one person take?  What a frustrating situation. 
Sweetie, I'm so hoping you get someone to talk to you soon!
hugs, Y

Thanks for your support.  I still have not heard from DR #1's office.  I have talked to the insurance coordinator for DR#2 and she said it is that easy....I have to attend to pre op class and a pre op with the Dr.   Furthermore, she claims she can get me the procedure I would prefer.  They she tells me the next available surgery date and it just happened to be the next available date that I could fit it in my schedule.  I was almost in tears.  Regardless of that, just having people answer their phones and return my calls is AMAZING!!!!!


So, I called and left another voice mail for the office manager for DR#1.  I told her if she would make sure that my records were sent to DR#2's office, I would not write the compan's main office (the sponsoring hospital) or the surgeon letters about why I was leaving.


So, here's to a little hope!!!!

Oh my gosh!!!!!!!  That really BITES that you have gone through all of this.  At least my office returns calls and emails - very good about that. 

Bravo for going to a different doctor - and HOW COOL that you can your preferred procedure - Awesome.

So have you hears back from #1 yet???? 

Suzy

CAn someone get denied or can being obese be considered a pre-existing condition if you were never being treated fro anything?

I think given today's insurance company's - I would not be happy until I had a written letter which specifically stated that you were approved and they have authorized  a specific procedure , time frame  - etc.

Otherwise - it is not really an authorization or guaranty of coverage...