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Psych hostage!!!

ok.here we go. I had my psych eval on April 23..called the drs office every few days after that trying to see if they had my letter of med necessity ready. was told daily by the secretary in the psych office that they were waiting on my stuff to come back from the transcriptionist.WTF?? So finally, monday MAY 11, i called again at which time i was told the same thing.I told the secretary that it had been 3 weeks and there was no way it was taking that long.so she went to speak with the dr about it. came back on the phone and proceeded to tell me that blue cross had denied their claim because precert was not obtained so they are not releasing my records until blue cross pays them. Now i work for the insurance company so when i made the appt, i walked her step by step on how and where to send her claim and about the need for precert.what more does she expect from me. I can't file the claim for her!! So I called the dept at bluecross that handles the claims and was told that it was denied because she did not get precert AND she submitted the claim to the wrong place(submitted it to psych instead of medical) but recall, i had already told her where to submit and everything.. So i told the lady in claims at BC all of this and she asked me if the psych eval was for clearance. i told her that it was for clearance for my WLS. She told me that she would follow up with the correct area and try to get them to overturn the denial. I have spoken with insurance everyday since then and still no decision yet. It's against the law for the dr to keep my medical record from me but the fact that she is even trying to makes me afraid of what she may write if i cause too big of a stink about the fact that it is against the law. So needless to say, i have a call in to another psych dr and hopefully i can get an appt soon so I can get this show on the road!! I work for the insurance company and am frustrated..imagine the frustration of the people that don't work day to day with this type of mess!! well, wish me luck!! As the Joss Stone song says, "i'm bruised but not broken"!!:smile2::w00t:
Sistabigbones

Sistabigbones

2
 

Just my view!!

Ok..I am going to go ahead and say it and I am sure some will not agree but...You MUST have good follow up care in order for the band to work. I had surgery a year ago and went to the dr faithfully EVERY month. Needless to say I NEVER saw my dr at these appointments only his "nurse". I begged for decent fills and was only given 0.5 cc every month. I was miserable..No restriction!! even 9 months out I only had 5 cc in my band!! so a lady that i met in my drs office waiting room told me about another drs office that accepted my old drs patients for fills. So 9 monhts afte surgery,less than 30 pounds loss, i switched drs. That was the BEST choice I could have ever made. I found out that there is a method to how much fill you are suppose to get on each visit with the first fill ranging as high as 4cc. Needless to say, my new dr gave me 1.6cc my first month with him. I lost weight that month but was not in the "green zone" yet so I went back the following month and was given 0.5cc based on what he and I discussed concerning my eating habits. It felt good to have how i was feeling dictate my fill versus what the other dr's office's "nurse" determined she would give me based on NOTHING!! So i guess what I am saying is that it takes more than just GETTING THE BAND PUT IN to make it work. The band is a tool and ALL tools require proper useage and that starts with the provider that you are trusting to be your guide in this. Thank you so much True Results of Atlanta Dr Orris's office for proving to me that I am not a failure. My other dr's office failed me..I did not fail my band!!! FINALLY losing like I should have been losing 10 months ago!!!:wub:
Sistabigbones

Sistabigbones

6
 

The process of getting clearance!!!

OK..so I am a healthy person other than being obese(is that possible??):thumbup: But anyway, I have my medical clearance and this morning, I went in for my psych eval. 500+ questions and it took me about 1.5 hours to do it. I will have to wait about 2 weeks to get those results back. I have an echo and stress testing on Monday. My last clearance will be my 3 hour nutrition class on May 11. I will have completed all of my clearances and can submit to insurance at the end of May.:tounge_smile: Hopefully, I can get a surgery date for sometime in July. I am excited and soooooooo looking forward to this. I know it won't be easy but neither is carrying around 256 pounds on a 5 ft 3 frame!!!
Sistabigbones

Sistabigbones

1
 

The stress test!!!

oh my!!! I had my stress test on yesterday. Picture this, 254 pound woman RUNNING at 5mph on a treadmill with an incline of 4!!! I was about to fall out!!! I had to ask the dr if he thought that was humane. :w00t: I am 254 pounds and there is no way in the world all of my meat should move at one time that fast on that incline and in that heat(the room was about the size of an oversized closet and had no air) The dr thought I was sooo funny!! but needless to say, I survived!! The last thing that i need to do is do my nutrition eval on May 11th and then I will be ready to submit to insurance! I am soooooooooooo excited!!! One step closer!!!
Sistabigbones

Sistabigbones

2
 

I'm Approved!!!!

Was submitted to insurance on thursday June 25 and i was called today by the blue cross csae manager and informed of my approval!! I am so excited!! Maybe I can get a surgery date in the next few weeks!!!!????? Wish me luck!:blushing::crying:
Sistabigbones

Sistabigbones

1
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