Insurance Question

It has been over 4 weeks since my surgeon's office said they submitted my file for approval for VSG.  In that time, I've spoken to the insurance company and the office a few times to check that everthing has been received.  The insurance company is adamant that they have not received the file and tell me repeatedly to call the surgeon's office to have them fax to a specific number.  The surgeon's office is adamant that everything was submitted to the right place and has been received with a "pending" status.  They think that every time I speak to the insurance company, I'm given incorrect information and that the insurance company will refuse to acknowledge receipt due to "liability issues".   I'm not sure what to believe at this point.  The last time I spoke with someone at the insurance company, they said that if it had been submitted, it would have been available in a couple of days.  I left a message at the surgeon's office on Wednesday and have not heard back.  Has anyone experienced or heard of an insurance company refusing to admit receipt of an approval request???

I suggest either asking the surgeon's office to submit it again OR asking them to provide you with a copy of everything they submitted, which you can then submit yourself.

The surgeon's staff may well have faxed it to the correct number.  It's possible someone on the other end lost it.  It's also possible the surgeon's staff accidentally faxed it to the wrong place or something.

I've never heard of an insurance company lying and saying they did not receive information they received due to "liability issues."  That makes no sense to me.

Thank you for the advice, Kelly.  That is exactly why I called the office on Wednesday - to ask if I could get the copies to send myself.  Still waiting for a callback...

The "liability issues" and the insinuation that they are lying doesn't make sense to me either.

Hi Irishpixie -  I had a similar situation. 

I had surgery ( 7 months ago ) through a large Center of Excellence hospital. Once I completed the pre-op requirements  I was told that they had submitted my paperwork. I waited three weeks and contacted my insurance. They did not have the submitted paperwork. Contacted the surgeon's office - I was told the did submit it. This went on for another two weeks before I was contacted by the Nutriontalist Department at the hospital I was using (Cleveland Clinic). The Nutrionalist had my paperwork (where it had been waiting for her completion) and she was calling with a question about my 3 months supervised diet.

She told me that once the Surgeon finishes his portion of the paperwork it is then sent to each department for sign off. My paperwork was stuck in a "department". Once the Nutrionalist completed her portion (I asked her to call me when she sent her completed portion back to the Surgeon) the paperwork was sent and approved rather quickly. 

My COE had three individual departments that had to approve/sign off on the paperwork - Surgeon, Nutrionalist and Psych.

Stay persistent, and keep calling. I would even ask the surgeon to resubmit (and get a copy for yourself). 

Thanks, Spot-N-Dots!  I am beginning to think I should have gone to the Cleveland Clinic instead.  I know that the insurance coordinator had everything to submit.  I saw the nutritionist long before the surgeon and during my meeting with the surgeon the nurse confirmed they had received her sign off.  I had trouble with them receiving the psych eval but that was resolved in a week.  I have asked them to resend twice now.  I'm not sure if they did or not.  I'm going to call today for a copy for myself.

You are doing great!  Keep up the good work!!

eeeeyikes - I work in health insurance I know that if they had received it - there would be a paper trail (I mean, if it was sent to the right department).

This is what I'd do if it were me.  I'd call my surgeon's office and ask for the office manager.  I would ask him/her to please resend even though you completely trust that they did so as they said they did.  Explain that the insurance company doesn't acknowledge receipt and that you are in the middle.  Would she please be willing to resend and then you make sure you have given her the correct person and fax # for it to be sent to.  And then YOU make sure to follow up to make sure it's been received.

Thanks for the reply.  At least I feel like I'm not going crazy here! 

I actually just spoke with my insurance coordinator who was AWESOME!  He emailed me the file he sent to the insurance company along with the fax confirmations.  The ins. co. is the problem which is what I had suspected all along.  I'm going refax to the number I was given and then follow up with them.  I have some questioned I would like answered.  I would think that even if it ended up in the wrong department they would make sure to send it where it belonged?! 

Thanks again :-)

I hope we both get an approval SOON!  Good luck!