Kelly C.

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Called Cigna and was told not only that I am still pending but that they are taking up to 30 days for approval.  I was also told that if more information is needed, they go directly to the phycians office.  If that happens, I have no idea how long it will take to find anything out.  If I am approved, they send a letter to the office and to me.  So let's just keep the fingers crossed for me to get approved on the first go-round.  The Cigna lady told me to check back in a week or two.  I think I may call tomorrow, just in case.  :)  BTW, I have heard from other patients that they are having trouble, too.  Good luck to us all.  One mentioned that they were going to Dr. Overcash, I need to stick it out at Dr. Jawad's.  For one, my dad loved him and secondly, Cigna referred me to him. 

So after calling the Dr.'s office, I insisted that I hold for Odalys and she took a look at my file and told me everything was complete.  Why hadn't she submitted the file to Cigna?  Who knows.  She was concerned that my primary care didn't make very detailed notes regarding my 6 month program.  I asked her to go ahead and submit my file to Cigna and see what they say.  This was last Friday and Odalys said she would sumit the file on Monday.  When I called Cigna on Tuesday, they told me the file was received and that it was under review.  Hooray!  Now the only hiccup that may come up is if those notes are good enough.  Cigna tells me that I will know on Friday.  If they need more information, Cigna will call Dr. Jawad's office and we will go from there.  You can imagine my frustration if that happens since the pre-determination team is either terribly busy or a bit off the mark.  It is Wednesday today so 2 more days to go before I call Cigna back.  Until then...

So I am getting a little annoyed with my surgeon's office.  I have not had a resonse to any phone calls or email's for weeks.  Cigna doesn't have my file yet and apparently my surgeon's office is ignoring me.  I did receive a bill for an additional $30 from Cigna - They covered all but $60 for the educational session.  I called the office on 1/10 to pay it.  I was sneaky and told the bookeeper that I also needed to return a call from Odalys.  When I spoke to her, I was told that I was missing something from my file.  Although I didn't really believe her, I resent my psych eval via fax.  She assured me that the eval. was all that was needed to complete my file and that it should be faxed to Cigna on Friday 1/11.  On the 11th, I emailed to confirm that everything was sent.  No responce.  I also called and left a message on the line that assures you calls are returned within 24 hous - well that was a week ago.  No response.  This week, 2 emails and 2 calls we not returned.  It takes a lot to annoy me and this office is pushing my limit!  I am invested in this physician's office so I don't want to leave but am trying to figure out if this is a sign or just bad customer service. 

Ok, so my Dr. office had a nice vacation but I am really hoping that they get back into the swing kinda quickly.  I got a message on Monday that Odalys is going over everything and will be in touch.  Clearly, I am not the only patient at this stage and I need to be a patient patient but, I am anxious to get the ball rolling.  Mainly because I have a lot of plans for this year and the sooner I have my health back the better!  I would rather wait and get approval than to rush and miss something important but I am just so impatient!!!!  Hopefully Odalys will let me know next week that my pre-approval has been submitted.

December 27, 2007 - When I was at the education session, I was told that the best way to reach the office would be through email.  After two email's that have not been answered, I went ahead and called the office.  Come to find out, they are closed until December 31.  Now, I would assume that they would also be closed on January 1.  This means that Odalys and the office in general will be very busy from the 2nd through the 4th catching up.  Why can't they put an out of office message on to let people know they are closed.  I am not angry, just disappointed.

So, I have been working on preparing for insurance approval since June.   Here is the quick version...

July 2007 - Attended Dr. Jawad's information session and had a consult with Dr. Dorn (my PCP).  Dr. Dorn is on board - 1 visit down, 5 to go.

August 2007 - November 2007 - Attended monthly appointments with Dr. Dorn.  Now on anxiety meds and I can actually sleep now!

December 6, 2007 - After my 6th appointment with Dr. Dorn, I had my bloodwork in anticipation for my 12/7/07 appointment at Dr. Jawad's office.

December 7, 2007 - Spent the day in Ocala.  Reviewed the various surgeries and complications.  This "educational" session was submitted to Cigna for approval and I only had to give my $30 specialist co-pay.  I am told this charge may be denied but they submit it anyway.  After the group lesson, I met with Odalys and Kevin briefly.  Odalys covered my pre-determination checklist and Cigna's statement.  Also, I was given recommendations for the psych. evaluation and nutritionist.  Gave them my files from 2003. 

December 13, 2007 - Had phone consultation with Jennifer at Dia-trition.  This was extremely convenient.  We went over a lot of the basics and pre and post op dietary needs.  She mentioned that she will see me at Dr. Jawad's office at my pre-op appointment and in the hospital.  She didn't accept my insurance but the $150 fee isn't too bad for what I am getting.

December 18, 2007 - Abdominal Ultrasound shows Gallstones.  We will be taking that monster out during surgery.

December 20, 2007 - Met with Dr. Marcil in Orlando for my psych evaluation.  We mainly just spoke for about 30 min.  Thankfully he takes Cigna.  Also, my evaluation came in the mail 2 days later.  

December 21, 2007 - Received fax from Dr. Dorn with letter and medical files.

December 26, 2007 - Emailed Odalys to confirm all of my pre-determination information is in their files.  No word yet.

I was not approved on my first WLS journey in 2003 and I am now begining to start along the path again.  I know it will be a big pain in the ass but it will make me better.  More to come...