Question:
How do I get my surgeons office to correctly go about the authorization process?

Ok long story real quick. Was approved for RNY 03/07 with first surgeon. Three weeks before surgery found out I was pregnant. Now trying to get authorization for RNY with new surgeon closer to home and better bed side manner but person doing authorization ( doctor's son!!!) doesn't know what he is doing. It has taken a month to get everything to insurance company and get an answer back and it was denied due to lack of supporting documentation!!! I am so frustrated and sad. I was a surgery authorizations coordinator for a doctor for 9 years and know this doctor's son doesn't know what he is doing. He is new at this. I need some advise on what to do. Thanks    — hannahsmom1014 (posted on July 25, 2008)

July 25, 2008
I am an RN who used to work for an insurance company doing these precertifications/authorizations and my best suggestion to you is to call your insurance number, get a Plan Handbook which should outline exactly what is needed for WLS approval. You shouldn't have to do all of the legwork here, but it looks like if you insist on the same surgeon, you probably will. Once you/doctor's office gets everything together, call the insurance company back and get the name, phone number with direct extension, fax number of the exact person that will be working on your preauthorization and deal with him/her directly. Mail it to his/her attention at the correct insurance address.... this way, it shouldn't be opened in the mailroom. Also send it by fax to the same person and ask for confirmation of receipt and an estimate of time it will take for review. Please also remember, you also have a limited number of appeals with most insurance companies. Get very stern and become a serious advocate for yourself with whoever you have to at the surgeon's office to get it right. After all, it is your life they have in their hands. The squeaky wheel gets greased. Raise heck. Good luck, Dawn Vickers, RN, BLC, CLC
   — DawnVic

July 25, 2008
You're in America: SUE!!! or... Take him under your wing. Let him know of your expertise and tell him your going to guide him down the path to authorization because IT'S HIS FAULT you didn't get authorized this time. If he balks... then threaten to sue for emotional damage, etc. Let Dad know. He can guide the son.
   — GaryLGreen

July 25, 2008
Had to chuckle at Gary's response. It would be better to talk to the Dad (Dr.) in concert with assisting them like Dawn said. Remember to perserverance is the key here.
   — C-There

July 26, 2008
Take a deep breath and relax....why depend on the Dr's Office to do it all....call your insurance company and ask what they need to complete this process......then GO TO your DR's office ask for the material they need to be photo copied and YOU send it and ask for signature required when sending to your insurance co. .......you have to realize that the office is flooded with patients....I'm not taking up for them but I wouldn't let them lag on this....and I'm a firm believer in taking matters into my own hands and seeing things thru.....It's your insurance company and they have to talk to you so why not do a little follow up of your own.!!!!! Good Luck.
   — pphillips4720aol.com

July 27, 2008
write to me [email protected]. I will attach what you need.
   — dessary316