I'm so tired of playing games with the insurance lady HELP!!

[spoiltmom 44]

Here's a link to my previous post to give you the back story:

http://www.lapbandtalk.com/f84/please-help-im-standstill-my-surgeons-office-117422/

'

Okay so after all that on June 30th the insurance lady told me she would get everything submitted that day to my insurance company. Now here it is July 12th and my insurance company hasn't received ANYTHING from her.

Now if I call her back she's going to be agitated b/c she told me to stop calling my insurance company. I want this done so badly. This surgeon is the closest to me at only 30 miles from my house but I really want and need this. Should I quit playing games with this woman and see a different surgeon? That would mean me driving 80 to 150 miles one way but I'm wondering if this lady even knows how to do her job at this point.

What would you do? I'm so frustrated:(

Edited to ADD: There is a surgeon that takes my insurance that ONLY DOES weight loss surgery. They can see me on the 20th and the lady on the phone was very, very friendly and helpful but they are a 2 hour drive.

The surgeon I'm trying to use locally is a general surgeon that also does Lap Band.

Edited July 12, 2010 by spoiltmom

[PuppyBandit 2]

I would go there, get copies of all of my files and drive the extra miles. You need supportive staff working WITH you not people with attitudes working AGAINST you. Isn't driving a little extra worth it?

[spoiltmom 44]

Oh and according to Allergan the out of town surgeon has performed at least 75 Lap Band surgeries last year. The local surgeon does not have that accreditation.

[AmberK 5]

First of all, who in the world is that woman telling you that you need to stop calling your insurance company???? I can't believe the nerve of her.

Second, have you called and talked with the office manager of the doctors office? Hopefully its a different person and you can complain about what this woman is doing. Its unacceptable how unprofessional she is.

[Amaris 0]

I drive about an hour and a half to see my surgeon; the drive is worth it to have a staff I can work with and a doctor I'd trust. I can't tell you what to do, but if I were you, I'd get copies of my files and go the distance! Good luck to you!

[tinksmom 0]

I would be more comfortable with an accredited lapband surgeon. How many lapbands has your general surgeon placed? However, if you like the current surgeon you might give them a wake up call and tell them that you are considering the other practice and want your records because of her inefficiency. The doctor and office manager might not know she is having problems with timeliness...or they may be trying to delay you to fit their own schedule.

[LeighaMason 19]

Run like you are on fire. :thumbup: (From Dr #1)

(I love this cliche and even though it really doesnt make sense, I still use it all the time.)

[spoiltmom 44]

Okay I called for an update and she said that she faxed the predetermination but she didn't get it done until July 8th b/c she was waiting on some of my med records. She said it was 40 pages total.

She also said she's not sure they are going to approve me which I already knew b/c I'm borderline on their co morbiidities. I asked her what their cash price is and she said $12,500 and then all my fills will be covered by my insurance under my copay. I asked her why and she said b/c they only charge for an office visit and don't specify anything. That sort of sounds like insurance fraud doesn't it?

But the problem is I have 3 kids at home ages 9, 3 and 3 months so If I use someone locally then I need a sitter for 2 hours for my follow ups. If I use someone out of town I need a sitter all day and I only have one sitter to choose from.

Advice?

[Froggie D 1]

I had a very similar situation with an office manager who was rude and told me to stop calling and bugging her. She lied and said the paperwork had been filed when it had not been. I waited 10 weeks for her to get me approved and nothing.

I changed to a different doctor and got banded within 2 months. I am so happy I made the switch. I realize now I never would have been successful with the first surgeon's office.

It takes a lot of support and knowledge to be successful and you deserve only the best. Go with a certified doc - don't let this woman be an obstacle in your path!

[SuziKur 0]

I'm so sorry you are having trouble but I don't think this is uncommon.. I just did what you are thinking of doing.. I was supposed to have surgery tomorrow and the dr. Office never sent the stuff to the insurance.. I am going to a new seminar tomorrow almost an hour further away.. I hope it works out for you.

[msdv 5]

I had a very similar situation with an office manager who was rude and told me to stop calling and bugging her. She lied and said the paperwork had been filed when it had not been. I waited 10 weeks for her to get me approved and nothing.

I changed to a different doctor and got banded within 2 months. I am so happy I made the switch. I realize now I never would have been successful with the first surgeon's office.

It takes a lot of support and knowledge to be successful and you deserve only the best. Go with a certified doc - don't let this woman be an obstacle in your path!

You need to leave this Dr and I would let him know exactly why. PLus you need to go to a Dr that is lap band certified.

As I said in your previous thread I am going through something very similar and I have been looking for another surgeon.

These surgeons don't understand that these snits in their office are a direct reflection of them.

I have an appt with my surgeon on 8/3 and I'm going to tell him exactly how I feel and if he doesn't say something to ease my fears I will then request all of my paperwork and go someplace else.

I think you should too and really think about how YOU feel and forget about these people being agitated or offended. Isn't that her job?

I was just telling my DH these folks are acting like I'm a charity case and their doing me a great favor.

My Mom used to tell me " always follow your first mind" it seems like you know you need to move on.