I am so deeply sad and frustrated...

[msdv 5]

I was originally given a surgery date of March 8th but all of my pre-surgery appts. were not done and I was told that it would take my insurance company (GHI) from 60-70 days to review and hopefully approve my case.

I submitted all of my paperwork on 3/16/10 that was 68 days ago today. I went on vacation last week and had every hope that when I got back I would have a message waiting on my phone telling me that I had been approved and I needed to call to set up a surgery date and start my pre-op diet. Well that didn't happen.

I called the surgeons office today and spoke to the admin.assistant who up to this time has been rather cold. I was told that they had to resubmit my paperwork last week because GHI says they never received them. If I hadn't called today I would never have known that and would still be waiting like a dummy.

I broke down crying. I'm crying now as I type this. I'm not a cryer but I feel so helpless. My weight is climbing steadily and I feel ugly and I am dreading the Summer.

I guess my tears made the formerly cold asst. feel bad because she said she would call GHI next week to try to rush them through.

I'm now looking at another 60-70 days to finally get word.

I don't know what I'm asking or needing with this thread but does anyone have experience with this? I guess I just needed to vent.

Do you think I should try to find another surgeon?

I'm in NY. The surgeon is Dr. Gorecki at NY Methodist . My insurance is BC/BS - GHI.

Please don't suggest I call the insurance co. that's like trying to reach Obama at the White House. I feel like giving up maybe doing the HCG diet or something else.

Sorry for the long post. I just feel so helpless and defeated.

Thanx in advance , Dee

[patsal 1]

I had a similiar issue as far as approval. I went in for my consult all other stuff (psych, nut, etc. done) in November. They said they would call me in late December early January to set up my surgery . I did not hear from them. I called in mid January. They accidentally refiled my chart and never requested approval from my insurance. Obviously it was good that I called. They asked for rush approval and I was approved in 24 hours. It was an honest mistake and before that everything was very organized and after that htey were very organized and professional as well. I had my surgery February 12th and honestly that date was better for me than December or January would have been since I didn't need to take any time off from work--February break.

Hang in there!

[msdv 5]

Thank you for your reply.

If rush approval is an option in my case I hope they request it.

[sil 0]

i know you are feeling ready to go. thats how i felt i had to wait 3-4 months after all my pre-op appointments.it will happen for you.good luck.

[msdv 5]

Thanx, that's exactly how I feel. Psyched and ready to go but now I feel like I need to go another route.

Once again looking for a diet. How did you lose 40 lbs before surgery?

[kagead 0]

I hate to say it, but you HAVE to battle with the insurance company on your own behalf. YOU are their client, not the Drs. office and no matter how efficient the office may be, they won't sit on your file the way you will.

I called my insurance company every single day after my surgeon submitted it.

If you call and ask, you may find there is a different department that handles files after they have been submitted. You may be able to speak with them rather than the general information group. I spoke with "predetermination", your company may use another term.

When you call, be EXCEEDINGLY friendly and polite. I used to make a joke about "yep, its me, calling to bug you again!" and I'd apologize and tell them that I was just so anxious for the approval. With one single exception, everyone who answered was great and even gave me "extra" info without me having to push too hard for it.

I know it is frustrating. I was in limbo from March 23 until I got my approval on April 29 (13 of those business days were waiting for the insurance company) so I know how you feel. But I also know you are your own best advocate and if this is as important to you as it seems, you'll do whatever you can to move the process along quickly.

Good luck to you!

kagead

[msdv 5]

Thank you, I will attempt to try again with the insurance company again tomorrow.

In my past experience I would call the # on the back of the card and get routed and re-routed to another # until I got back to the original # without ever speaking to a person.

I understand exactly what you're saying and I will try to get them from early in the morning.

[msdv 5]

Well, I did call the insurance company today myself. I got on the phone with them 1st thing this morning and surprisingly I got to speak to 2 people.

They told me that there is no claim on file for me. So according to them the claim still has not been submitted.

I called the surgeon's office back and spoke to the program coordinator and insisted that they get on the ball. I hate dealing with people that give you one excuse after the other for just being negligent.

I told them that if they did not care and continue to treat me like I'm begging them for free services that I will pick up all my paperwork and go to another surgeon.

She said that she will call me tomorrow but I'm not holding my breath .

Now, I'm looking for a new surgeon. I hate this !!

This whole episode makes me skeptical about the surgeon too and if I don't get a resolve tomorrow. I will write him a letter telling him so.

I'm so depressed about this.

[kagead 0]

While I am sorry about the outcome, I am glad you took matters into your own hands.

No need to be depressed- be grateful that you may have found out your surgeon is not the right one for you. Much better to find that out NOW rather than post-op when you will REALLY need them to be responsive.

Hang in there and stay aggressive!! It will work out the way it is supposed to!

kagead

[HiMow 0]

just so you know, it took me a over a year to get approved. I gained weight the entire time and it was so depressing. In a couple years you will laugh at how upset you got. I cried too, but it DID finally happen for me and it will for you too.

Also, I had a hiatal hernia repair that the insurance company is still trying to bill me for!!

Yes, you will have to call the dr. and the ins company about a million times. You will probably memorize your policy number :biggrin: But, it will all work out!!!

stay positive!

[msdv 5]

Thanks for replying LBT friends.

I can't help I do feel depressed and I just don't know which way to turn but I'll make my decision tomorrow.

The Dr. has gotten good reviews and the hospital is a good 1 in NY. I don't know if he's aware that his staff is so lax but I will make sure that he does after tomorrow.

I'll update tomorrow.

I wish I could go to the Dr's at NYU. I started with them but my insurance is out of network with them . They said they would accept whatever my ins. pays as final payment but I just don't trust that. I'm not poor so I just can't figure why they would do that. I would be afraid of getting hit with a big bill after surgery.

HiMow , why did it take you a year to be approved? it's been almost a year in this process for me because I had to do the 6 month medically supervised diet and then finish my tests and now it's been almost 3 months waiting for approval and now their saying another 2-3 months so it will be a year in all or more for me. :biggrin:

[sydney1976 0]

I waited and waited a bit too. My insurance has a whole Bariatric department and once I touched base with them it was approved in less than 2 days. :biggrin:

Good luck!

Sydney

[LRTAB 0]

The surgeon I will be using was recommended by my primary care doctor who I trust explicitly. He has an outstanding success rate and his former patients rave about him.

But his nurse who manages his insurance is horrible.

Similar to you, it has taken NINE MONTHS to get approval. And I didn't have an insurance company requirement to try 6 mos of diet counseling, etc. They kept telling me that I needed X, or Y or whatever. Truth be told, I think that she had enough patients backlogged that she just processed the ones she knew were sure things and ignored me (my company has a PPO plan with a company in California, and it is not common with most businesses in my home state).

After the year ended, I let it ride because I knew my wife's scheduled gall bladder surgery would help us hit our deductible this year. Once we did, I took matters into my own hands. I called my insurance company and got the list of pre reqs and *I* managed the process. I confirmed with the nurse that I had the right process, then I did all the prereqs myself. When done, I called all the people I had to see (Psychiatrist, nutritionist, etc) and made sure they had sent the paperwork and when. Then I asked her to submit or refer me to another surgeon, which she did and two weeks later I was approved.

Also, I called my physician who may have helped shake things loose with his peer as well :biggrin:

Bottom line is, this is your health and your responsibility. Don't let someone you don't trust own the process. If you aren't tied to the surgeon, find another referral. Call your health insurance provider and get the list of requirements and approved surgeons. Call them all. I believe this surgery will be the greatest decision I ever made (except marrying my beautiful wife!). Its worth fighting for!

Best of luck to you, and don't give up!!

[Me3 0]

Don't look for another surgeon... it feels like it is the fault of the Dr.'s office, but from my experience, it ALWAYS is the insurance company.

I have Humana and got the same line - we haven't received your claim... oh no? Well 3rd time around I asked the insurance company for their fax number and mailing address. I overnight expressed with delivery confimation so the punks had to sign for it. No more line of "I didn't receive it!"

I also bugged the crap outta them... everyday... and yes, it was frustrating, BUT the payoff is worth it!

I would also suggest that you call your Dr's office and ask them for the phone number that they use to call your insurance company and demand that they give it to you. It's usually a separate number then the back of your card and is a more direct line to the bariatric section of your insurance company. If they still refuse, then call the insurance company back and ask them for the number to the bariatric center and if they won't give it to you ask for a supervisor and don't take no for an answer.

I'm so sorry that you have to go through it, but I have been there and I know how raw it makes you feel. Defeated. Hopeless, etc. DON'T GIVE UP!

Go easy on yourself too. I know you wanted to get the ball rolling for "summer", but look at this a little more practically. It's 1 week from being summer. Even if you got approval tomorrow, the pre-op and surgery wouldn't be until mid summer and the weight doesn't come off quickly in the beginning. So.. look forward to the skinny mini next summer and rock this summer knowing that you are making positive changes for you!

Much Love, Understanding and Hugs,

Heather

[Froggie D 1]

I feel so bad for you. I had a similar experience and, NO it is not always the insurance company. Here is my story.

I went to the seminar and waited months to see Dr. Niazy Selim at University of Kansas Medical Center. I had one appointment and was told all my paperwork looked in good order. Dr. Selim's comment was, "I wish all my patients had things as well organized as you do. It should take about a week to get everything sent in to your insurance." I waited two weeks and heard nothing so I contacted my insurance and was told they had received nothing. I asked them to contact my surgeon and find out what was wrong. They called over and over and tried for weeks to get the paperwork faxed in without satisfactory results. I called the surgeon's office multiple times and emailed several times trying to find out what the hold up was. Once his staff got on the phone, two of them, I was told to let them handle it and relax. Twice I was told all had been sent in.

Nearly 3 months after my appointment they told my insurance nurse that my case had been closed. I called the Patient Advocate at the hospital and was told, "They decided they could not develop a theraputic relationship with you, so they closed your case." I had two questions - Why? and - Why wasn't I informed? I was told (1) that my insurance was too difficult to deal with, (2) that they could not finish the paperwork as they did not have a psych eval (the insurance already had it and no one asked me for it or I would have provided it) or a dietician eval (I hand carried that in and gave it directly to the doc along with the other paper work he was so pleased with), and (3) that I was not a trusting person as I kept calling over and over to find out why they had not sent in my paperwork. They could not explain why I was not informed.

The Patient Advocate referred me to the Cheif Operations Officer who, after talking to me a long time, told me I seemed really rational and logical, not at all what the surgeon's office described when he investigated, but there was nothing he could do or I could do.

So I filed a complaint with the Blue Cross/Blue Shield folks as KU Med Center is a Blue Distinction Center. I am sure it will not really result in anything concrete, but it made me feel better to take some action.

This was all last summer in July and August. Since then, I found a surgeon with a great staff. I went to a seminar the end of January, went through the whole process, and had a surgery date set by March 8.

I was banded on April 7 and have lost a total of 40 pounds now. I am down from a size 2x to an 18 and feeling great.

I was just as upset, angry, frustrated, and all as you are. I cried a lot. I ate way too much and gained weight. But I kept after it and finally got my band. I still have 83 pounds to lose, but I am getting there one day at a time.

It will happen for you! Find a new doctor if you have to. Keep pushing and don't give up! I am thinking about you!

Edited May 26, 2010 by Froggie D