Insurance frustration
I have read about so many people having problems getting the initial approval for their surgery. Of course, I turn out to be another. My insurance co. sent a letter requesting more info on Oct. 21st. They asked for some additional information from the doctor as well as the dietitician. Drs. office faxed everything over immediately. This past week they decllined me because the doctors office didn't send documentation that I finished the 5 coaching classes that are a part of their company. The coaching classes are with Health Partners!! They should have a record of it since it was their coaches that were calling me. When I called the insurance company they said the Dr. should have gone online and gotten documentation that I completed the program and faxed it along. Oh wait...they now notice I am in CA and there would have been no way for my doctor to get access to that information because CA drs dont have access to it!! UGH!
But instead of sending me and my Dr. a letter asking for the info, they automatically declined me! I have people from 3 depts working on it but 2 of them feel that I will have to go thru the appeal process. Someone from the appeal dept said he will try to pu**** thru now but he will get back to me. I am told this has never happened before...I honestly don't believe that I am the only person from CA to have this surgery and need to complete the coaching calls and approval. So now it is sit and wait for them to decide how to get information from one of their depts to another.
But again, why did they not notify me they needed the documentation before declining me? With the first letter they faxed, they did NOT say they needed this. And...they gave us 45 days to get the info to them. (Dec. 5th) . I don't want to lose my surgery date and they are all assuring me that that wont happen.
Just very frustrating...
But instead of sending me and my Dr. a letter asking for the info, they automatically declined me! I have people from 3 depts working on it but 2 of them feel that I will have to go thru the appeal process. Someone from the appeal dept said he will try to pu**** thru now but he will get back to me. I am told this has never happened before...I honestly don't believe that I am the only person from CA to have this surgery and need to complete the coaching calls and approval. So now it is sit and wait for them to decide how to get information from one of their depts to another.
But again, why did they not notify me they needed the documentation before declining me? With the first letter they faxed, they did NOT say they needed this. And...they gave us 45 days to get the info to them. (Dec. 5th) . I don't want to lose my surgery date and they are all assuring me that that wont happen.
Just very frustrating...
Sherry T
Dealing with insurance companies can be very, very frustrating. Of course they should have told you in the first place that they needed that documentation. Of course they didn't do their job correctly and now they are denying you for something they goofed up. And of course you're ready to drive over there and slap them upside the head for it.
Listen. I don't mean to minimize the stress and frustration you're dealing with. In the end, though, you'll get approved if you have to appeal. This is like a roadblock or detour on your journey but you're still gonna end up in the same place, it's just gonna take a little longer than it should have. And I know it's hard to be patient because you really wanna get there, but I think this is the time to focus on your destination, not the roadblock.
Listen. I don't mean to minimize the stress and frustration you're dealing with. In the end, though, you'll get approved if you have to appeal. This is like a roadblock or detour on your journey but you're still gonna end up in the same place, it's just gonna take a little longer than it should have. And I know it's hard to be patient because you really wanna get there, but I think this is the time to focus on your destination, not the roadblock.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
Thanks Kelly, I know that it will all work out in the end. I just don't want the surgery date pushed into next year, or any closer to the holidays.
Your right, HAHA ...I do want to drive over there and slap them! It is like a DUH! issue...it is your company, your computers, your staff...why don't you have the info? But eventually, it will work out...just frustating.
Your right, HAHA ...I do want to drive over there and slap them! It is like a DUH! issue...it is your company, your computers, your staff...why don't you have the info? But eventually, it will work out...just frustating.
Sherry T
I would not want my date changed due to their stupidity either. But whenever you have surgery, it will be a great time to have it. If it's near the holidays, well, what a great holiday gift to yourself that is! And it if is in the next year, what a great way to start the new year!
Be frustrated, vent, get it out of your system. But then refocus yourself and know it is all going to work out. Don't lose a lot of sleep over it.
Be frustrated, vent, get it out of your system. But then refocus yourself and know it is all going to work out. Don't lose a lot of sleep over it.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
Sherry:
Things will work out. I know how frustrating it can be to worry that the
surgery will get delayed or derailed because of the ineptitude of someone
at an insurance company, but hang in there and don't let yourself get
stressed out too much. Focus on meal plans, things you'll take to
the hospital, reading about the surgery, planning for your vitamin
needs and all the "stuff" you'll need to have and know for when you get
home. That should help make time fly by. If it gets pushed out a bit,
well........you'd make that work.
I had my surgery on Dec. 21st last year, (which was scheduled only
about a week in advance of the surgery) and got home on the 23rd.
I signed on a little house I bought on the 20th and my DH picked up
the keys after I got out of surgery in the morning- and got us all
moved in and then picked me up and brought me home to the new
house for Christmas. We didn't have a tree or gifts, but we had a
fantastic Christmas just the same. I had some family over and I
managed to heat up a nice ham and make potatoes, veggies and
dinner rolls, with pies for dessert. Of course, I had a protein drink
and jello, but I couldn't have been happier. Things have a way of
working out.
I wish you the best and here's hoping for smooth sailing and quick
approval!
Things will work out. I know how frustrating it can be to worry that the
surgery will get delayed or derailed because of the ineptitude of someone
at an insurance company, but hang in there and don't let yourself get
stressed out too much. Focus on meal plans, things you'll take to
the hospital, reading about the surgery, planning for your vitamin
needs and all the "stuff" you'll need to have and know for when you get
home. That should help make time fly by. If it gets pushed out a bit,
well........you'd make that work.
I had my surgery on Dec. 21st last year, (which was scheduled only
about a week in advance of the surgery) and got home on the 23rd.
I signed on a little house I bought on the 20th and my DH picked up
the keys after I got out of surgery in the morning- and got us all
moved in and then picked me up and brought me home to the new
house for Christmas. We didn't have a tree or gifts, but we had a
fantastic Christmas just the same. I had some family over and I
managed to heat up a nice ham and make potatoes, veggies and
dinner rolls, with pies for dessert. Of course, I had a protein drink
and jello, but I couldn't have been happier. Things have a way of
working out.
I wish you the best and here's hoping for smooth sailing and quick
approval!
Jan
Thank you Kelly for your support. You amaze me! To not only have surgery but to move at the same time takes a very strong woman! I actually had a warm feeling when reading about your Christmas and can tell it was very special.
I have been approved finally, thru persistence paid off. I think if I hadn't followed thru with the insurance company each day that it might have taken longer for the approval.
Thanks again for replying!
I have been approved finally, thru persistence paid off. I think if I hadn't followed thru with the insurance company each day that it might have taken longer for the approval.
Thanks again for replying!
Sherry T
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