Question:
Insurance/Surgeon coverage
My insurance covers Bariatric surgery and i qualify but my insurance is just now verbally saying that my surgeon is on their plan but the Bariatric center says that they need it in writing before they can continue the process. It has been 3 months now. I m only understanding some of this, can any one out there tell it to me in dummy term and why is it taking so long? The surgeon was not a covered provider until June 1st. The center received verbal confirmation that my insurance will pick up my surgeon as a provider but they want that in writing, how long does something like this normally take? — candy L. (posted on July 18, 2008)
July 18, 2008
I know it can be upsetting. It took me 8 month to get my surgery.Call your
insurance that you need it in writing and they may fax it over to you and
your doctor. I hope this helps.I know the paper work is the hardest part of
the whole thing. Annette
— Mrsjhupp
July 18, 2008
I was very frustrated too dealing with the insurance co. vs. doctor's
office. Got lots of conflicting information, etc. To be honest I think
the insurance companies do it on purpose to discourage the surgery as they
really don't want to pay. In my case I do believe that by me calling
constantly and asking to talk to managers that it did make a difference.
First of all you need to get to the right person at the insrance company
which can take some doing. Jut move up the ladder until you get to a
person who can send a letter. Just keep asking for the letter until they
do it.
I thoguht I was NEVER going to get the surgery and then all of a sudden the
sea parted and I had apprpoval from ins. com AND a surgery date all in one
day...all of this w/o even meeting the surgeon yet.
INsuranc companies and WLS centers all have their sets of rules and hoops
to jump through but one thing I learned was that when they are motivated
they seem to be able to do whatever they want. Go figure.
I think it might have helped that I complained (in a nice way) to anyone
who would listend AND I started oging through another WLS program and told
them about it...that's when things started moving.
I had my surgery Jan. 14, 2008 and I've lost 85 lbs. I'm VERY happy.
Good luck to you.
— cjjordan
July 18, 2008
Sometimes it just takes time to do thing. If I were your surgeon, I also
would not take a verbal ok from an insurance company, it could be a serious
financial loss for them. In the society we live in today you need your
agreements in writing, and that is the professional way to do things.
Being assigned as a provider just takes time, and you can call your
insurance company about once a week and just kindly ask them about the
progress of your case, and after several weeks of being persistant (and
kind), they will see they need to move on your request. Patience,
persistence and kindness will pay off. We always have to be pro active in
our own health care. It just takes work, and as you do that, you will at
least be informed, and perhaps help move it along. Be sure and ask them
your questions. You are paying thousands of dollars in premiums to a
health care industry that spends millions and makes millions off the
american public every year. Don't be afraid to question them and get your
answers, you pay for it. Take care. Patricia P.
— Patricia P
July 19, 2008
CJ is right on the money. You are going to have to make calling your
insurance company your new hobby. Call EVERY day. They are not your
friend. They are a business and the longer they can delay any kind of
approval or payment the better (for them!)
— MAG
July 19, 2008
Hang in there Candy. Become a nuisance to your insurance company.
Unfortunately, I did not have the time to make a bunch of phone calls to my
insurance company. However, my wife was very supportive and made the time.
For a couple of days she made phone calls constantly back and forth
between my surgeon's insurance specialist and our insurance company. I
think they got tired of her phone calls because after those couple of days,
we had insurance approval and a date for my procedure. Be persistent and
good luck.
— Michael M.
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