Rant - I need to be calmed down

I posted before how the surgeon's office was taking forever to turn my paperwork in to the insurance company for WLS approval. Well, Friday I spoke with them and was told that it would be submitted by the end of that day for sure.

I woke up this morning excited and having to make myself be patient enough to wait 2 days to call the insurance company and verify that they have indeed received it.

I received a call this morning from the surgeon's office telling me that they cannot submit my paperwor****il July 9th because my surgeon is out of network with Cigna. On the 9th, somehow they will be in network. WTH?!?!? They knew I had Cigna since day 1. I have used my insurance for all of my visits there - at leat 5 so far beginning back in March. And they are JUST NOW telling me this? I am BEYOND confused AND frustrated!

Thanks for letting me vent...

I understand that you are frustrated and beyond pissed at the office manager and insurance folks at your surgeons office.  I would DEF write a letter to him or talk to him about the run around you have gotten from them on that front.  He needs to know to keep his people on top of these things and that keeping patients completely in the loop is important.

However.....

They have done you a HUGE favor.  Because had they submitted it previously, you would be stuck paying a large chuck of the costs out of pocket at the out of network rate.  I know you are excited and ready to get this journey underway, but that right there is a blessing in disguise.  My surgery was only covered 50% by my employer and I had to pay the rest out of pocket.  I would have GLADLY waited a few more weeks to get more of the costs paid by insurance. 

Look at it this way, you have a few more weeks to research and prepare yourself.  I assure you there is a silver lining.  Might not help with the frustration you feel right now, but I know your bank account will be happy for the delay.

Maybe their contract run out and they plan to have a meeting and renew it in July 9th?  A few more weeks - it is frustration - but considering the rest of your life - it is a short wait.
Use this time to educate yourself on the new diet -life style. Even 4 years post op -I am learning things.

Thanks you two. I know in the grand scheme of things a couple of weeks is really not that big of a deal. I lost sight of that in my frustration. Thanks again for helping me focus.

I guess the irritating thing is that why didn't they just tell me this Friday? I spoke with them Friday late afternoon and the were definitely submitting it that day. Maybe 3 hours made a difference... who knows.

So does that mean your insurance will not be paying for the pre op appts you've already had, if they are out of network?  Or that you will have to pay larger copays?

I don't know yet, Kelly. That is part of my frustration. Cigna has been sending me EOB's that state that some things are not covered but yet they say that I do not owe anything yet. I have also received a few letters from Cigna telling me not to respond that ask the Dr. for some form of documentation regarding their claims.

I do know that the medical center that I am having my EGD at is only going to charge me my 20% coinsurance even though they are out of network; the same for the surgeon doing it (the bariatric surgeon). Cigna will only pay them 50%. They said that they will just accept what Cigna will pay them, plus my 20%.