Recent Posts
Topic: UHC and a run around, anyone else?
I've been trying to obtain approval from UHC (Choice Plus PPO) for a couple of months now. My patient advocate at my surgeon's says they are faxing items over, and the nurse case manager is saying she isn't receiving it. Is this a common issue with anyone else?
I was denied earlier this month because they did not have my psych eval info or my 6 month diet info. That has been submitted twice so far this week and they are still saying they are not receiving it. Now, they say they have received the diet, but not the psych eval. And they say that the diet doesn't count because I was pregnant. The diet took place a few months after I gave birth, they even have all of those medical records showing that. Is it possible they are causing this run around just so they don't have to pay for the surgery? We certainly pay enough on our insurance premium. It's just becoming a huge frustrating mess. Any suggestions on how to get the ball rolling and get an approval? thanks!
I was denied earlier this month because they did not have my psych eval info or my 6 month diet info. That has been submitted twice so far this week and they are still saying they are not receiving it. Now, they say they have received the diet, but not the psych eval. And they say that the diet doesn't count because I was pregnant. The diet took place a few months after I gave birth, they even have all of those medical records showing that. Is it possible they are causing this run around just so they don't have to pay for the surgery? We certainly pay enough on our insurance premium. It's just becoming a huge frustrating mess. Any suggestions on how to get the ball rolling and get an approval? thanks!
Topic: Window for surgery after approval
Hello,
I have run into another wall with my insurance. My out of pocket is going to be $5,000 and I am going to have to think about if we can swing this. If I do what is necessary and I am approved, how long is that approval valid?.
I've been in the dumps all day and really want to cry.
My insurance is with UHC if it makes any difference. Thank you!
I have run into another wall with my insurance. My out of pocket is going to be $5,000 and I am going to have to think about if we can swing this. If I do what is necessary and I am approved, how long is that approval valid?.
I've been in the dumps all day and really want to cry.
My insurance is with UHC if it makes any difference. Thank you!
Topic: RE: So upset with my PCP
Ditto.
I didn't really care what my PCP had to say on the topic, I don't really remember if I told him before surgery or not but I opted not to jump through ins hoops and self pay instead.
If I would have opted to do the six month nonsense I would insist on a doc that was behind me all the way.
On December 14, 2010 at 9:40 AM Pacific Time, windyacres wrote:
Not me - I would go see another doctor who will be behind my weight loss plans. No game playing for me!Ditto.
I didn't really care what my PCP had to say on the topic, I don't really remember if I told him before surgery or not but I opted not to jump through ins hoops and self pay instead.
If I would have opted to do the six month nonsense I would insist on a doc that was behind me all the way.
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
Topic: RE: Insurance Denied by Dr Bertha with 2 weeks to surgery date
I don't really agree with you on this one. Just because someone takes an oath does not mean they 'really mean it' at all. How many doctors do you think over the last 100 years really believe in specific healing Gods? (Can't remember their names right now.) Do you really think that all the docs that are willing to do abortions really believed in the oath?
To be honest, it's kinda like saying people never lie in court because they took an oath.
How do you know if they really meant it or not?
If you google it you will very likely find a lot of the oaths people are writing to replace the Hippocratic one.
On December 14, 2010 at 10:18 AM Pacific Time, windyacres wrote:
I'm all about full disclosure. If a doctor takes the Hippocratic oath (and means it) you know where he/she is at. I just want to know what sort of oath they took - it may be better, it may be worse.I don't really agree with you on this one. Just because someone takes an oath does not mean they 'really mean it' at all. How many doctors do you think over the last 100 years really believe in specific healing Gods? (Can't remember their names right now.) Do you really think that all the docs that are willing to do abortions really believed in the oath?
To be honest, it's kinda like saying people never lie in court because they took an oath.
How do you know if they really meant it or not?
If you google it you will very likely find a lot of the oaths people are writing to replace the Hippocratic one.
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
Topic: RE: Insurance Denied by Dr Bertha with 2 weeks to surgery date
I'm all about full disclosure. If a doctor takes the Hippocratic oath (and means it) you know where he/she is at. I just want to know what sort of oath they took - it may be better, it may be worse.
Edie
Approved 8-1-11, Surgery 8-22-11 SW 231, Goal 140, CW 165
Topic: RE: Insurance Denied by Dr Bertha with 2 weeks to surgery date
I don't have a problem with a medical professional getting a fair payment for their services, but I do think this doctor should have informed his patients with this insurance that there was a dispute with the insurance company, especially for those patients who would be expected to have their surgery around the time the doc was ready to drop the contract. I don't feel that was ethical behavior and I would complain both to the insurance comissioner and to the state medical society.
Why is it a problem? They make their own oath. Just because they don't use the Hippocratic oath doesn't mean their own oath isn't perhaps better. The Hippocratic oath is for new docs that they swear upon the healing Gods several issues. If they don't believe in multi-healing Gods, wouldn't it be a little weird to say the oath?
The Hippocratic oath also has the doctor swear to the healing Gods that he will not cause abortion and he will not give a lethal drug even if asked. Some believe in abortion and some believe in assisted suicide.
So it's really not that great, I wouldn't take that oath.
On December 14, 2010 at 9:27 AM Pacific Time, windyacres wrote:
Well THAT is not comforting! I think they should post their ethical standards on the walls of their offices so that the patients can decide whether this is someone they want treating themselves or their families. I, for one, would not want to see a physician who felt he/she was unable to promise to at least "try" to do no harm!I don't have a problem with a medical professional getting a fair payment for their services, but I do think this doctor should have informed his patients with this insurance that there was a dispute with the insurance company, especially for those patients who would be expected to have their surgery around the time the doc was ready to drop the contract. I don't feel that was ethical behavior and I would complain both to the insurance comissioner and to the state medical society.
Why is it a problem? They make their own oath. Just because they don't use the Hippocratic oath doesn't mean their own oath isn't perhaps better. The Hippocratic oath is for new docs that they swear upon the healing Gods several issues. If they don't believe in multi-healing Gods, wouldn't it be a little weird to say the oath?
The Hippocratic oath also has the doctor swear to the healing Gods that he will not cause abortion and he will not give a lethal drug even if asked. Some believe in abortion and some believe in assisted suicide.
So it's really not that great, I wouldn't take that oath.
Previously Midwesterngirl
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
The band got me to goal, the sleeve will keep me there.
See my blog for newbies: http://wasabubblebutt.blogspot.com/
Topic: RE: So upset with my PCP
Not me - I would go see another doctor who will be behind my weight loss plans. No game playing for me!
Edie
Approved 8-1-11, Surgery 8-22-11 SW 231, Goal 140, CW 165
Topic: RE: Insurance Denied by Dr Bertha with 2 weeks to surgery date
Well THAT is not comforting! I think they should post their ethical standards on the walls of their offices so that the patients can decide whether this is someone they want treating themselves or their families. I, for one, would not want to see a physician who felt he/she was unable to promise to at least "try" to do no harm!
I don't have a problem with a medical professional getting a fair payment for their services, but I do think this doctor should have informed his patients with this insurance that there was a dispute with the insurance company, especially for those patients who would be expected to have their surgery around the time the doc was ready to drop the contract. I don't feel that was ethical behavior and I would complain both to the insurance comissioner and to the state medical society.
I don't have a problem with a medical professional getting a fair payment for their services, but I do think this doctor should have informed his patients with this insurance that there was a dispute with the insurance company, especially for those patients who would be expected to have their surgery around the time the doc was ready to drop the contract. I don't feel that was ethical behavior and I would complain both to the insurance comissioner and to the state medical society.
Edie
Approved 8-1-11, Surgery 8-22-11 SW 231, Goal 140, CW 165
(deactivated member)
on 12/13/10 11:18 am - LOUISVILLE, KY
on 12/13/10 11:18 am - LOUISVILLE, KY
Topic: RE: sleeve vsg has anyone had it approved?
Well on this case its not the ins co its my husbands employer.I am appealing through the his union. So this will be very interesting.....Thanks
Topic: RE: denial from cigna?
OMG. I finally got my approval a week ago....It took me 3 weeks to get the approval--and then I find out it as the WRONG approval. Cigna said my hospital was "out-of-network." I've been waiting since November 9. I've been going thru all of this since the end of April! I've done EVERYTHING Cigna wanted me to do. The sleep studies, the pulminary tests, the bloodwork, ultrasounds, the 6 months diet and excercise, the psych evaluation....This is insane! I just don't understand how I could hold up my end of the bargain...and them **** on my heart!
Ummm according to their website AND when I got my pre-approval, everything was all set!
Today I spoke with my insurance coordinator (I was in Vegas when I got the letter saying that it was out-of-network this weekend) and she said she'd handle it.
She called me after having it fixed, but it makes me a little nervous since it's not in writing. I was supposed to pay what was left of my admin fee, my optifast, and get my date today, but I want to know FOR SURE what to expect.
We'll see....
good luck to you!
Ummm according to their website AND when I got my pre-approval, everything was all set!
Today I spoke with my insurance coordinator (I was in Vegas when I got the letter saying that it was out-of-network this weekend) and she said she'd handle it.
She called me after having it fixed, but it makes me a little nervous since it's not in writing. I was supposed to pay what was left of my admin fee, my optifast, and get my date today, but I want to know FOR SURE what to expect.
We'll see....
good luck to you!
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They say that the journey of 1000 miles begin with a single step, but the truth really is that the journey of like a million miles begin with a foot on the scale...--me.
View my website!
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