Question:
What can I do to get the surgeon and clinic insurance staff on the ball?

I submitted my information to the clinic insurance lady on 9/4/01 and all the packet needed was the letter from the surgeon attached. Well apparently the surgeon has not even written her letter yet because the insurance lady still has not submitted my packet to my insurance company. I have called her several times and she will not return my calls. What can I do to get the ball rolling. It has been almost a month with nothing happening. I only have a 60 day appeal time and I received my denial letter on 8-9-01 (day of my first surgical consult) so I am getting close to that deadline. Any suggestions?    — Lynda T. (posted on September 25, 2001)

September 25, 2001
As a reimbursement specialist for a large teaching hospital, I am involved with the appeals process. A successful appeal rarely is based on just a "letter" from the physician. A good appeal has to include detailed clinical information which can take a while. Also, it's possible that the documentation has been forwarded to your insurer. Appeals go to designated departments and have to be logged in....that can take a couple of weeks...during which the insurer will say that they have "no record" of an appeal. I can understand how frustrated you are with the lack of response. Try emailing her. I answser my emails much quicker than I answer my phone calls. Also, try calling early in the morning before she gets deluged with the work of the day. When you leave a message, make sure you leave your name, phone number, the date of the call and a brief summary of why you are calling. I often receive messages asking me to "Please call Mrs. Jones at 555-xxxx". I don't return those calls....I simply don't have the time. Physicians and hospitals are overburdened with denials that have to be appealled.
   — [Anonymous]