Does Your Insurance Coordinator Tick You Off As Bad As Mine Does?

[hm734 228]

Vent session: I will just feel better if I complain to someone. Feel free not to read any of this. LOL

Before commiting to my surgeon on May 1st I stressed to them several times that absolutely needed my surgery to happen in July. My husbands work requires that he takes no time off from Aug 1st-Nov 1st due to the nature of his work. They are very strict on this, as they have an extremely flexable schedule any other time of the year. Not to mention, football season also starts on Aug 1st. He coaches my sons team and I am team Mom for my daughters squad. I need to be at each practice 4x a week and every game on Sat. I explained our situation in great detail on my very first visit, and I was assured by both the practice manager and my surgeon that this would be no problem.

I should note that I had been planning this for over a year with my PCP before she moved her practice to another state. I already met all of my requirements for insurance, reguired no pre-op clearance other than the psych exam..and have been pretty much ready to rock. My coordinator is horrible.I have done every single thing that I could possibly do on my own to speed this up. I submitted everything to my insurance, I called them directly to get updates (without being annoying), I got the approval code, I faxed them the approval letter...the whole shabang.

I found out today, that despite having been approved early last week that the coordinator still has not forwarded my information to the pre-op team for scheduling. She somehow "overlooked" it. This is the only thing this woman had to do. I couldn't help it, after being sweet as pie to her for 2 months I snapped. I asked her what exactly she does do. After a long pause she told me that it was likely I would now have to wait until late August as they had scheduled over 10 surgeries today alone because of some new Medicare approval crap. Really??!! My pre-authorization is only good for 60 days. With my schedule if it does not happen in July my next shot is November. This would require vacation time for both me and my husband, a whole new application for pre-auth and I will also be in a new benfit year so the 2000.00 I put into co-insurance will not have mattered, and will have to meet that amount all over again. As it stands right now, my insurance said the only bill I wold get would be for my TV if I choose to turn in on.

Of course, I have a plan B and do have another surgeon that can schedule me for July 19th. My issue is that I really wanted to have my surgery with this specific surgeon. I have 100% confindence in him and he is very skilled and respected in bariatrics. My other option is less experienced, and most of his surgeries have been lap band and bypass. I asked for a specific number on sleeve and was not given even a round about number, just that he was more experienced in the others. This makes me really, really nervous.

What do I do?

[Ready4success 380]

Hi,

I know you're frustrated but try to calm down and think a few things through. If insurance was submitted and approved, then I think you should escalate the issue up to an office manager? Supervisor? There has to be someone to talk to besides the co-ordinator. Also, all those pre-scheduled people won't have their co-pays, or pre-op requirements completed for a date this soon. Doesn't Medicare have a co-pay too? Anyway, let the office know that you want to be notified of anyone canceling, or pushing their date back. One last thing, FILE a formal complaint in writing to the office about the way your case has been handled. It sounds like the co-ordinator is purposely not being helpful. Good Luck!

[Erin6573 10]

I would call and ask to speak directly to the surgeon, and keep calling and leaving messages until you talk to him/her. The surgery, if no complications are found is literally like 30 minutes. Explain the situation again to your surgeon and see what he can do, after all the insurance coordinator is his employee and he would most likely like to know if they are not doing their job. I had a similar situation with a surgery my son had to have and I was relentless until I spoke to the surgeon and got it all worked out. Good luck and remember the squeaky wheel gets the grease!

[LizEac 32]

I know that this is incredibly frusterating. I had been planning for over a year to have a June date. My co-ordinator always seemed to be on vacation, only worked until 3pm. And didn't seem to know how to do her job. I am a substitute teacher, and needed to work summer school in order to pay the bills. She puts in my paperwork late and lo and behold, I'm July 13th. So, this now means that I can't work this summer (by the way, preparing for surgery is not the time to be broke, I'm just glad I got a contract for the fall. I know how you feel, and it's important to have a community to vent to. But something I'm realizing is, I am making an amazing change to my life, and yes...this summer will suck. But next summer will be phenomenal. I wish you all the best!