Question:
Does any one know about not having to have a pre-certification for surgery.

My husband called the Insurance company , and they told him that they no longer take pre-certification. she said that you have the surgery, and then everything is submitted I guess, she told my husband that they have paid for alot of the wls. I dont know, I called the Dr. office and talked to the assistant, which she got a little snappy with me , and said for us not to call the insurane that she handles all that.    — Melissa R. (posted on August 31, 2000)

August 31, 2000
Dear Melissa, I am sorry you received such a response from someone at the docs office. Maybe she was just having a bad day but I say "Out of line and unprofessional, period". I am guessing that you are trying to find out if you will have an out of pocket, or worse, and you need to know if you can afford this, or what needs to be submitted or done with the insurance. In my medical office I loved patients like you. I could be sure if I asked you to call insurance or whomever to help resolve a problem, "You" would actually do it. So right now you do not know where you are at with your submission. Does your doctors office have a manager? Is this assistant also the insurance or referral person? See if you can enlist another person in this doc's office to come to your aid. I do not know how all offices are run but in mine; nurses and assistants did nursing and assisting and came to me with insurance or referral dealings. That was what they were trained to do and best at and I respected that and insurance was my area. They have paid for a lot of the WLS is not an answer...like a lot of WLS is not my WLS if you understand my meaning. You need to have your insurance policy; the exact wording of what they do and do not cover and you need to know what was sent if anything to the insurance. From there; are they covering this surgery or not? Not go ahead and have it then declare bankruptcy because they won't cover. Insurance submission can be a complicated field but you have the right to know everything about your case medically and financially. I commend you for trying to be your own advocate. Finally, if the staff of this doctor is being less than professional this should be brought to the attention of the doctor. It is HIS practice and they are usually so busy being the DOC they assume everything out front is going smooth and do not know Miss so and so has an attitude problem
   — JennyLynn A.