Question:
When Drs. office says they handle it all, should i not call Champus?

Its been 2 weeks since my surgeon visit. They file it all. I dont mind waiting on the surgery but would like a date! If i dont hear soon, should i call champus or will it jeopardize what the Drs office is doing?    — Jackiis (posted on October 10, 2001)

October 10, 2001
At this juncture, let the surgeons office handle things. His office staff has the contacts and knows "what" to say. You don't want to chance mucking things up. Two weeks isn't long at all.... if you are concerned...follow up with the doc's staff. I handle insurance appeals and often procedures are denied because patients submit uncessary or conflicting information which gives the insurer an "out". I'm working on one right now, a breast reduction for a 17 year old obese boy. The surgeon's office submitted documentation supporting the "medical" need for the surgery. But for some odd reason, the mom sent in a long letter explain her son's embarrassment about his body and detailing his emotional anguish etc. etc. I suppose she thought she was helping. But, her letter gave the insurer the opportunity to deny the operation as a "cosmetic" procedure. I'll get it straigtened out and approved eventually....but....if she hadn't interferred the kid would have had his operation during the summer. Now we'll be lucky if we can get it scheduled durign the christmas break.
   — [Anonymous]

October 10, 2001
Hi, I have Tricare and they do go about approvals differently than most insurance companies. I am getting mine done at a Naval Hospital by a Military doc, so procedure may be different if you are going to a civilian. I do know that in the handbook that it states that you have to be 100 lbs. overweight or BMI 40/35 with co-morbs. I did not have to write up a letter, or deal with tricare, my surgeon did everything. Two weeks is not long to wait, I know it is hard to be patient. I have been on a waiting list for 7.5 months, waiting is definitly tough at a time like this. Let your surgeon handle the approval process, call to see how the ball is rolling. Good luck.
   — Cheri M.