Please help I'm a standstill with my surgeon's office...

[spoiltmom 44]

I live in a small town. We only have one surgeon's office that does Lap Band but he gets GREAT review so I decided to use him. But I can't get anywhere with his insurance lady and you can tell I'm making her mad.

I've called my insurance company 4 times and 4 times they have told me that a 6 month supervised diet is NOT required! Okay so I go in on Tuesday for my psych and nutrition eval so I called her to ask her when she will submit this to my insurance for approval and she said not until I've finished my 6 month diet. I then told her that I was told no diet is required and if for some reason there is they will tell us in writing when the surgeon submits the paperwork. She said that is NOT how she does things. She said the 6 month diet IS required by my insurance company and she will NOT submit anything to them until it is completed. She then told me to quit calling my insurance company and call her instead b/c she knows more about it then they do. Edited to ADD: She said she does NOT DO APPEALS and that's why she wants the diet done before submitting it.

Well I feel like I'm being cheated:( If the diet isn't required then I could get this submitted and approved 5 months sooner. But instead she's going to make me wait the 5 months and finish the diet first that my insurance isn't even requiring. I don't want to make her mad b/c that is the only office in town that does Lap Band but at the same time I'm mad and I don't feel like she's listening. I used to do medical billing for a living so I'm not a complete moron and I know what to ask the insurance company and I'm getting different answers than she is.

My insurance company said they would call and tell her no diet is required but I know that will tick her off b/c she thinks she knows it all.

What do I do now??

Edited June 30, 2010 by spoiltmom

[PuppyBandit 2]

I would be leary of doing the surgery there, she is the person you will be having to work with. Is there a bigger city close by? Driving some more miles for a more experienced doctor would be good

[msdv 5]

So what if she gets ticked off???!!!

This is btwn you , your surgeon and your insurance company. She cannot tell you to stop calling YOUR insurance co.

This ticks me off because the people that work in my surgeons office delayed me getting approved for my surgery because of negligence , thinking they know it all and just bad patient relations.

It is not up to your surgeons office personnel to dictate to you that you need to go on a 6 month diet if your insurance does not require it.

These surgeons better recognize that these people are a direct reflection on them. If my Dr. did not have favorable reviews I would have gone elsewhere because of his staff.

I had to go through all the testing and the 6 month med. supervised diet and then wait for them to take an extra 3 months to submit my papers. It has been over 9 months that I have been going through this.

I finally just found out last Wednesday that I was approved for my surgery because I called my insurance co. I rec'd the letter from them on Saturday and still have not heard from my surgeons office. I'm waiting to see if I will get a call from them this week. If not I will call them Monday morning.

Unfortunately a lot of people and even the nurses that work in the hospitals look down on this surgery and the people that choose to go this route.

You have to be your own advocate as I was advised when I came here to vent about my frustration.

This is your life (literally) it is enough in itself to decide to have this major surgery . The extra rigamorole that these folks put you through is totally over the top.

Speak up for yourself . If you have to ask to speak to the surgeon and ask him if this is just his requirement regardless of what the insurance co. says. I doubt he'll say it is. They want to make their money and move on.

I guess you can tell I'm really miffed about my situation and after my surgery I do plan on writing my surgeon a heartfelt letter.

Edited June 30, 2010 by msdv

[spoiltmom 44]

Okay I called my insurance company AGAIN and my dh's HR dept and what it all boiled down to was THE FREAKING LADY NEVER CALLED THEM!!

That's right the insurance company pulled up all my notes and said that the only time she called them was today and she's never called them before that.

So the lady called me back 20 minutes ago and said OK I talked with your insurance and they don't require the diet after all so I'm submitting this and hopefully you'll be approved by next week.

I'm so aggravated with her. I knew she couldn't have called them b/c they wouldn't tell me one thing and tell her something else.

Now I just HOPE they approve me. She said if they approve me right away then I can be banded by mid August at the latest.

Cross your fingers for me guys!

[msdv 5]

Now see that !!!!

What if you didn't push it and just skulked away and went on with the 6 month diet for nothing?

If you didn't say you were in a small town I would be sure you were in NY dealing with the same heifers I'm dealing with .

Congrats to you!! I hope you get approved quickly.

[AmberK 5]

I would call back and ask to speak with the office manager to discuss with her what this lady has been pulling. If not, then definitely mention it to the doctor. That is just unacceptable.

And how awesome that you dont have to do the 6 month diet! That freakin rocks!

[Tally23 0]

Okay I called my insurance company AGAIN and my dh's HR dept and what it all boiled down to was THE FREAKING LADY NEVER CALLED THEM!!

That's right the insurance company pulled up all my notes and said that the only time she called them was today and she's never called them before that.

So the lady called me back 20 minutes ago and said OK I talked with your insurance and they don't require the diet after all so I'm submitting this and hopefully you'll be approved by next week.

I'm so aggravated with her. I knew she couldn't have called them b/c they wouldn't tell me one thing and tell her something else.

Now I just HOPE they approve me. She said if they approve me right away then I can be banded by mid August at the latest.

Cross your fingers for me guys!

File a complaint with the manager of the office. I work in a medical office and no one deserves to be treated like that. If anything they should tell her to get an attitude adjustment or get out.

[eyd 0]

I feel like I have jumped through hoops to get to this point. My surgery date is August 27, 2010.

I went to the first seminar in November 2007. In January 2008 I found out I had the wrong insurance. I couldn't switch my insurance until November 2008 or I could pay for the procedure on my own. So I resubmit the paperwork in January 2009 and found out it was the wrong insurance plan. So I had to wait until November 2009 to change my insurance again. But this time I called the surgeon's office before I changed my health insurance to make sure that I had the right plan. I even talked to the surgeon and lucky me he had remembered me from the previous year and he said this the year you get this done.

Everyone in my surgeon's and my primary care doctor's office is GREAT!!!!!! Even the psychologist was GREAT. After that it was easier but by this time I was diagnosed with diabetes, sleep apnea, and high blood pressure as well as the PCOS I had since I was 18. The one doctor that gave me the hardest time was the nutrionist. She is only available two days during the week.

I guess what I am trying to say is that at the end of the day if it is meant to be it will happen. You just have to hope for the best!