wtf???

BeatrizS1974
on 6/22/12 12:52 am
So as most of you know i am scheduled for surgery on July 2.  But still waiting for the pre-certification to be approved by the insurance.  I have met all the requirements. 

So i called the insurance company a few minutes ago.  The rep says to me Well it looks like its is non-cert'ed  I said to her what the heck does that mean?  She said it looks like it was not approved.  I said why.  She said hold on let me look at the files.   I said fine.  She put me on hold for the longest minutes of my life.  She came back on the phone and said looks like you were sent some paperwork and you did not return it.  I said what paperwork?  They have not sent me any paperwork.  She said please let me put you back on hold so i can look into it further.

Well that felt like FOREVER!!!!!!  She came back on the phone and says. I am sorry but i have to back track.  It looks like the status of your claim changed today and unfortunately it does not show if the certification was approved or not approved.  I was like WTF????  I told her i am scheduled for surgery in 10 days.  If there is something they need i want to be able to send it in so that i dont lose my surgery date.  So she said she was going to mark the file urgent and that they would send me a letter in 7 to 10 days??????

ARE YOU ******G KIDDING ME???? What part of im scheduled for surgery in 10 days don't you understand.  

I swear i don't know if i want to scream, cry, throw something.  I let a message for my navigator at the surgeon's office but haven't heard from her yet.

Anyone have any suggestions or thoughts???
happiegirl
on 6/22/12 1:26 am - Albuquerque, NM
VSG on 04/24/12
Did you call the rep at your surgeons office?  Maybe they can help pu**** through?  lol I called and called and called everyone.  I will pray that everything turns out ok and this is resolved.  I know it sucks...I had so many problems too...even when I was approved it said RNY and I had to go back and have the insurance fix it.  It was crazy!  You will get there.

HW: 351 Pre-op: 272  Current: 140.7 Goal:160      M1:14 M2:14  M3:11  M4:10 M5:10  M6:12  M7:8  M8:6 M9: 6 M10:7 M11: 6 M12: 4 M13: 5 M14:7 M15: 4 M16: 3 M17: 1   M18: 4

 
"Glory lies in the attempt to reach one's goal and not in reaching it." - Gandhi
 

    

BeatrizS1974
on 6/22/12 1:30 am
I did call the rep at my surgeon's office,  got her voicemail so i left her a message and also emailed her.  I have not heard back from her. 
Cindy22706
on 6/22/12 1:29 am - California, MD
VSG on 02/08/12
Yeah I would call the surgeons office, I called my insurance company and they told me something about not having paperwork or something and I called the insurance rep for my surgeon and she called and said the lady didnt know what she was talking about and that I was approved.
  
moonglo82
on 6/22/12 1:30 am
VSG on 03/29/12
Sounds like you got someone who didn't know what they were talking about. I would call back and pray I got someone else on the phone... insurance companies usually have so many people answering calls all day that I doubt you would get the same person twice.

And if you don't feel like you got any more information, ask to speak to someone higher up the chain. Keep calling until you get the information you need to get this sorted.

    
Highest weight: 277 Starting Weight: 250  Surgery Weight: 241  Current Weight: 130

Goal Reached in 10.5 months :)


 

(deactivated member)
on 6/22/12 1:44 am - WA
would it speed things up if you had the paperwork faxed over instead of mailed?
BeatrizS1974
on 6/22/12 1:47 am
Thanks for all your advice!  I called back the insurance company and this time asked to speak to someone in the Pre-certification department.  She told me that i was not approved because of lack of proof of necessity.  Called the surgeon's office again and the receptionist told me that my navigator would call me back because she was on the phone with my insurance company.  Will update you all again when i hear back from the navigator. 

I feel a bit better now.  I went through my insurance benefit plan and everything that they asked for was sent to them.  I don't understand what the hell else they want? 
moonglo82
on 6/22/12 2:04 am
VSG on 03/29/12

I didn't go through insurance, but it sounds like maybe the doctor's letter of necessity didn't have enough information on it.  Sounds like the doctor's office is taking control and doing everything they can... maybe it will be resolved soon.

Keep us posted!

    
Highest weight: 277 Starting Weight: 250  Surgery Weight: 241  Current Weight: 130

Goal Reached in 10.5 months :)


 

BeatrizS1974
on 6/22/12 2:06 am
Thanks!  I will keep you posted.

BeatrizS1974
on 6/22/12 2:41 am
Ok, so i spoke to my navigator.  She said that the person that she spoke to her told her i met all my requirements but that the reason it was not approved is because it has something to do with how the surgery will be performed??? What the heck does that mean.  The person i spoke to told me that it had to do with lack of medical necessity.  Honestly i think they have no F'ing clue what they are talking about! 

She also told me that supposedly the insurance company sent out a letter yesterday explaining why it was not approved.  They could not read the letter to her.  They said they could not retrieve it.  What a crock of ****!

So i will have to wait until monday,  or Tuesday, which i have my consent signing appointment, to find out if i will have surgery the 2nd!

I wish i could pay for the surgery myself cause i would tell the insurance company to SHOVE IT!

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