Sherry T.

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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 push it 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...

I feel like I am finally moving forward. My insurance company required that I have 5 coaching calls with their program before they would approve surgery. I have one left in 2 weeks...but was concerned that I wouldn't be able to get a surgery date this year. I was hoping to have RNY the second week of November. I asked my case manager to send for approval to the insurance company. She did this and also told me the dates available were Nov 22nd, the Tuesday before Thanksgiving, and Nov. 29th...the day after my birthday. My husband thought Nov 29th would be best so we are penciled in pending insurance approval. I have my pre-op appt set so am ready to go now. I can't wait!