Mixed Messages

[Tiffany Talbert Corbet 46]

So I just called the UHC member number and asked if they could give me any information regarding the progress of pre-approval for the sleeve procedure. I was told what information they request from the dr's office, etc. (which I already knew....that wasn't the question!) and then was told I would have to talk to someone in the Care Coordination department. Prior to transferring me, she looked up in the system to see if there was any additional information. In there she found an in-patient pre approval for a surgery 8/31 - 9/1. I'm guessing this might be my date! Except.......

Then when she transferred me to Care Coordination, I got NOTHING in the way of information. The best this lady could tell me was that it was still under review. She couldn't tell me if they were going to request more information (since they blindsided me with height/weight requirements for the past 5 years.....that I wasn't told about the two times I called asking about coverage and requirements needed for approval!), or if there was an indication of when an approval would be made. The best she could tell me was I would know when I (or the Dr) was notified via mail or if I (or the Dr) called back to check on the status.

REALLY!? Are they using the same computer system? Neither my husband nor I have surgery scheduled (I've NEVER had surgery) and there's nothing wrong with my husband that would require an in-hospital stay, let alone surgery.

SO.....I prefer to believe my surgery date is going to be 8/31 and will just wait patiently for the Dr's office to call with the approval and the instructions for what procedures need to be performed prior to the surgery.

Has anyone else had this type of encounter with the insurance company? I've never been through anything like this with the insurance company in the 13 years I've had coverage with them, but then the most I've ever had to have covered by them is my visits to the OBGYN and an EKG to see if I have a heart murmur. Other than that, I just pay my $10 copay, and wait for the letter showing the coverage I have and what was paid by insurance on my behalf. (I'm a lucky girl, I know I shouldn't be bitching this much....just anxious to get this started!) 43 years of being overweight, and this tool is presented to me as a MAJOR weapon in my battle against the bulge, and insurance is making me suffer with the waiting game.

That's ok, when it's all said and done, I WILL be victorious in this war!

Tif

[traceyinflorida 499]

Insurance companies are so annoying!! I cannot count the number of times we have been through the same nonsence with myself or one of my family members. Do you have a bariatric or surgical coordinator at your surgeon's office? I found that I got much more direct and straight forward answers when she called the insurance company. Good luck.

[Tiffany Talbert Corbet 46]

I do, but when I called them this afternoon (2:30) I got the answering machine and didn't receive a call back. Hoping maybe they'll call me tomorrow morning.

This is the same office who forgot to request my psych eval (that I had a month prior to meeting with the surgeon) to complete my paperwork to submit to the insurance initially. I had to call the physchologist and, it turns out, the dr. office emailed requesting the eval right after I left the message. (Maybe because I called the Dr's office asking if it had been submitted when the insurance company told me they had nothing?)

Then, after they had that, it turns out the insurance required 5 years of height/weight history (which no one told me the 2 times I called insurance before starting this to find out if it's covered and what the requirements are). So I had to chase down those records since I've only been seeing my PCP for 2 years.

I'm an Exec Asst., and the "misses" I keep encountering are really rubbing my OCD the wrong way.

I work very hard to pay attention to details in my job, I expect those in similar positions to do the same, and when they don't, I feel like I'm having to do a supervisor's job. (Yes, I'm ranting just a bit.) One would think for each patient they would have a checklist that matches up to their insurance requirements so they can make sure they have all the information needed prior to submitting to save the "bumps".

Like I said, maybe they'll call in the morning and will be able to get a more decisive answer than I got. My husband says I just need some patience. (DUH) He knows I want this yesterday, but I need to slow down and just wait. {sigh} He's right, I just don't like it when he is!

[traceyinflorida 499]

If you do not hear from them in the morning, then you should call them back. Thinking back on it, I got further with my bariatric coordinator when I emailed her voicing my frustrations with the insurance process when I had been denied twice due to a couple of missing words from my PCP in her letter of medical necessity. She had not answered my voice message. Do you have that option?

I know it's frustrating, especially when you are a detail oriented person. For me, I felt like...Okay I have done everything I needed to do on my part for the past six months, now it is in your hands and you are %*!@# it up!! Hang in there, and keep bugging them, you know what they say about the squeeky wheel.... Before you know it, this will all be behind you!

[chitowngirl 885]

I work in healthcare, first the date your surgeons office submitted could have just been tentative, as many companies require a date in order review a request. As far as uhc, their c/s reps are all over the place. When I have to call them, and if I get someone whose an @ss or just sounds dumb, I hang up and call right back. So call back again today and hopefully you'll get a rep that is more helpful.

[Tiffany Talbert Corbet 46]

Thanks, Tracey....thanks chitown....it's always amazing how much info everyone here has and how willingly they share it! I'm sure they're busy first thing in teh morning, so I will give them a bit to get settled into their routine of the day and give the dr's office a call again.

[jacksmommy719 63]

Hi! So, I can’t tell you how happy I am to find your post on this topic, because that is exactly what I was trying to find out myself! I live in NJ and I too have UHC (Choice Plus Plan). I went to my initial appt a few weeks ago and was immediately told by the insurance advisor for the dr that UHC required a 5 year weight history, a list of pre surgery tests and BMI over 40 or over 35 with co morbidities. They also said that UHC required 6 monthly visits with the physician prior to surgery!! That kind of stopped me in my tracks! It literally took me about 6 months to get the nerve to even go see a surgeon and now that I made up my mind I have to wait another 6 months??? So I did some digging around and asked a few people that I work with that had bypass (and have the same insurance) if they needed to wait 6 months too. No one did! They did need their 5 year weight history and psych evals, but no one waited 6 months. So, my next step was to call UHC and ask them. I called them 5, seriously 5, different times and got 5 different answers…(pulling my hair out at this point). So, the dr’s office basically said, after I go for all the required tests and provide the 5 year weight history, that they would submit to the insurance for pre approval and see what happens..now, I wait…

I feel your pain, trust me..My advice to you is, call the UHC number that “providers” use. It’s a different number then patients use. Ask for care coordination and see what happens. Get a reference # and an operator # each time you speak to them so you can track your calls to them. Good Luck!! Keep me posted!!

[mufasas-mom 170]

With UHC - do you not have to contact the Bariatric Team at UHC? I did and I have UHC CHoice Plus as well - and did the (well still doing) the 6 months, psych, ekg, pulmonary testing and blood work. Did not have to provide 5 yr weight history and I DID contact the Bariatric Care with UHC who mailed me a list of all the documents and testing that they require prior to approval. So i knew from Day One what the process was. You should call the #800 number on the back of your ins card and ask to speak with a Bariatric Specialist - that should get you the correct answers.

[jacksmommy719 63]

Mufasas-mom, Unfortunately, the plan that my company has with UHC does not cover Bariatric services, just the surgery..isn't that strange???

[mufasas-mom 170]

wow - that is very odd..... well at least they cover the surgery -so that's good.

[lovealways 22]

I keep getting mixed messages too about requirements, etc. No one seems to know much. I have UHC Community Plan. I'm doing all the pre-op work now...but geez...some answers would be nice.

[traceyinflorida 499]

I am convinced that the insurance companies make theses things as difficult as possible so that you will give up and go away and not try to get expensive proceedures covered. It just makes me all the more determined and persistent. I wish everyone who is dealing with this issue lots of luck and patience. I know it is dissapointing to find out that you have to wait another six months when you are finally READY. It happened to me too. Trust me when I tell you it goes by pretty quickly, so try not to be discouraged.

[ebonisekim 1,713]

Yes it's frustrating ... I'm waiting another six month cause my ppo provider change to Aetna so I'm follow there requirements even thoe it didn't take effect until aug ... I'm two months in

[Tiffany Talbert Corbet 46]

Well, I finally got an answer. I'm APPROVED! And I didn't get the news from the doctor's office. I got a letter in the mail on Tuesday from UHC. I called insurance on Tuesday (before I got home and got the letter in the mail) and was told that it was approved. So I called the doctor's office, and of course I have not received a call back. I have not talked to the coordinator in the surgeon's office since they called the week after my appointment asking for additional information because I called them on forgetting to submit my paperwork! I'm just about at my wits end. I'm trying very hard to be patient. I don't like doing other people's work, and I shouldn't have to be the one to persist with the office to get some feedback on the next steps! I want so badly to let loose and let them know how I feel, but I don't want to piss anyone off prior to the procedure. So I'll probably hold my tongue and share my opinion when I get that all to often submitted survey from the hospital asking about my experience. (Probably not good that I'm an Exec. Asst. for a Senior VP at a national construction company, and former McDonald's GM from a tourist community so I'm high on details and customer service.) Everything I'm experiencing is definitely rubbing me the WRONG way. (Oh, and of course this is my PMS week.....those poor girls.)

[Tiffany Talbert Corbet 46]

So I took my chances and called the dr. office. Amazingly, the coordinator was who answered the phone. I was very calm. I told her that I was calling for an update because I had received an approval letter from the insurance company on Tuesday. She told me she had not seen a letter from them yet, but it may be in the mail and just not made it to the office yet. (really?) She said even if it's still not in the mail, she will call the provider number for the insurance to get the case # and then get the file to the Nurse Practitioner, who will get with me to schedule the tests needed. (Then she asked if I had had any of the pre-opt tests like the endoscopy....really? You haven't returned my calls.....how can I be scheduled for anything?)

Anyway, the good news is, they're finally on the ball again. I feel like I have to goose these people just to keep them moving forward! (And here I was afraid losing the weight was going to be the hard part.)