Question:
I was rejected for wls by my doctor's office because a hmo lost my medical records.
I completed the psych eval, physical, health questionaire, attended the support meetings and provided medical records from my 2 most recent doctors (1995 to present). However, my doctor's office has advised me that they will not even schedule an initial consultation because they are concerned that my insurance company will review my case after the fact. Has anyone else been in this position? My medical records show co-morbid conditions and all the other information fits into their requirements. My insurance company does not require any preauthorization and I meet their criteria. I feel my doctor's billing staff has cold feet. I work for my insurance company and I already know the policy for pymt of this surgery. The nearest wls surgeon is 2 hours away and I would like to remain with the surgeon my doctor has recommended. Does anyone have any advice????? — Lisa J. (posted on November 14, 2000)
November 14, 2000
I know exactly what you're going through! The same thing happened to me
just a few months ago. Was I ever mad! I gathered all of the information
that I needed & had it faxed to my surgeon who then faxed it to my
insurance. I called the insurance one day & the say it is pending. The
next day they tell me it is missing because they sent it to the wrong
place. No one seemed to know what happened to my entire medical file! I had
my surgeons office resend everything & FINALLY got an approval. I had
to call my insurance company 2 or 3 times a day & question what was
happening. It seems to me that they were just stalling so as to not have to
approve it. Be persistant,keep calling & if you have to,start
collecting all that info again & have your doc resubmit it. Best of
luck to you!
— melmas
November 15, 2000
if you surgeon is concern about payment and you are not, maybe you should
put you money where you mouth is and put the money up front to cover the
surgery and get reimbursed by the insurance company.....you have to
understand the surgeon is looking out for your best interest....without
preapproval if the surgery is done and you DON'T have the records to prove
that you meet the criteria you could get stuck with a HUGE bill, the
surgeon has dealt with the insurance companies before and knows what they
look for.....I think that you are taking this too personal....if you are
certain that you meet the criteria, pay for it in Cash and have the
Insurance company reimburse you
— Jack N.
November 15, 2000
You know very seldome do people respond to post ugly, you know
use this site like this,(use what you can,overlook the post
you have no use for) go with Melissa's advice it sems the
most logical way to proceed. I am willing to bet not to many of
us can pay cash for our surgery, that is why we share information
on what we have done and what works for us in hopes that it
may help someone else.
— Tamaria W.
November 15, 2000
You know very seldome do people respond to post ugly, you know
use this site like this,(use what you can,overlook the post
you have no use for) go with Melissa's advice it sems the
most logical way to proceed. I am willing to bet not to many of
us can pay cash for our surgery, that is why we share information
on what we have done and what works for us in hopes that it
may help someone else.
— Tamaria W.
November 15, 2000
You know very seldome do people respond to post ugly, you know
use this site like this,(use what you can,overlook the post
you have no use for) go with Melissa's advice it sems the
most logical way to proceed. I am willing to bet not to many of
us can pay cash for our surgery, that is why we share information
on what we have done and what works for us in hopes that it
may help someone else.
— Tamaria W.
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