I'm So Irritated I Could Scream!

[barbi1281 112]

I just want to scream right now! I'm done everything I need to do... have been finished for nearly two weeks... and when I met with my surgeon last Wednesday, he told me that my packet would be with the insurance coordinator by Thursday and off to the insurance the same day... so why is it Tuesday and not only has nothing been sent off... no one answers their phone or returns calls?!?!

I did actually talk to the insurance coordinator yesterday who proceed to tell me that she wasn't sure what to do since I had double coverage and this is being covered by my secondary since it's an exclusion from my primary (I called and informed her of that on her voice mail on THURSDAY morning when I asked her to call me so we could discuss this and how to submit it)... She told me yesterday that she'd given it to the bariatric surgery coordinator and that I needed to speak with him - I left him a message yesterday morning and have called several times since - no return call. Finally today, fed up I called and requested to speak with the office manager only to get her voice mail as well... all set to leave a message but her voice mail is full! You'd think I'm talking about some small mom and pop operation but NO - I'm dealing with MedStar which is one of the biggest medical operations in the MD/DC/VA area!

I even started to give them benefit of the doubt - maybe they went ahead and submitted to my primary insurance company without calling me back... so I called my primary to find out - NOPE! They can't submit without a surgery date and I know we haven't scheduled it because they're still passing my file back and forth and no one's calling me back! I'm seriously one more unreturned call from finding a new surgeon! I'm so pi$$ed because this whole fiasco has potentially set me back weeks and my whole thing was that I wanted this to be done by the end of September so that I could be 100% myself by Thanksgiving which is when we start decorating for Christmas in my house (Christmas is a HUGE deal to my family).

[imgonnaloseit! 30]

Oh, man, Barbi... I feel for you, girl. What a conumdrum!

I would try the insurance coordinator one more time, as well as the bariatric surgery coordinator. If I didn't get to talk to either of them, I would be heading there in person first chance I had and not leave the office until something was accomplished. No yelling, no cursing, just asking who and why until it's done.

Maybe threatening to change to a new surgeon might help. Heck there has got to be quite a few very good surgeons in the DC area.

Hope it gets resolved for you sooner than later.

[GeauxForIt 659]

That stinks!! I can see how you'd be ready to strangle somebody. LOL

Can you maybe go up there and try to see someone? I hope things go smoothly from here on out. <3

[Ms skinniness 3,003]

I would call and talk to anyone and just plan let them have it..... The squeaky wheel is the one that gets the oil! Speak with the doc. Go in person if you have to. You have more than earned this. Best wishes!

[Izuri 428]

I would call and talk to anyone and just plan let them have it..... The squeaky wheel is the one that gets the oil! Speak with the doc. Go in person if you have to. You have more than earned this. Best wishes!

Not that Ms skinniness is wrong, because she often gives wonderful advice, but I'd go with the exact opposite of this approach. I would call if I haven't heard back in a few more days and be level headed but firm. I have worked in customer service all of my working life and in my opinion when I'm a customer there is almost never a situation where it's ok for a customer to let loose on a representative (The few exceptions being rudeness, repeated inaccuracies, anything far abnormal, etc), especially when it's someone who is not even involved in the situation to begin with. And I can tell you that I'm 110% more likely to go out of my way for someone who is appreciating the time and effort I'm taking.

Keep in mind - Insurance companies are not a one size fits all. Neither are insurance plans. I don't work in medical billing, but I do work with insurance billing on a daily basis and things take time. Have you called your insurance company to ask about information? Sometimes it takes forever. Half the time I call them and they refer me to another department, which then transfers me back to the first, and so on. I spent a good three hours one morning last month trying to get something to work through an insurance company - and I work in face to face patient situations - that is a lot of time to sort out one problem when you're also trying to help customers. And the insurance coordinators have to do this on a daily basis, with intricate plans and insurance companies with representatives that cannot always interpret the plans. Not only that but they have to dual bill - which may mean that they have to submit to your primary payer for a denial before they can submit to your secondary. If it is anything like the experiences I have had with insurance, I do not envy the coordinator!

The second part is they are a big facility, correct? So imagine your situation times x number of patients they probably having waiting on approval from insurance. There are probably stacks of files to be processed and the more time you spend answering how long it's going to take, is time that is taken away from actually doing their job of getting it processed. You are talking in business days - most places don't stay open on the weekend. So that's 3 business days, if you include today.

My point is not to tell you you're wrong for being frustrated, because I was freaking while waiting for insurance to process too, but it's that both what you feel and the response you are getting from the office are normal for big offices. If you had talked to her over a week or two ago and heard nothing, I would start being more upset, but it's not even been a week in business days. I know that having a time frame and getting a date and everything is a wonderful feeling - and I promise you will get it - but sitting here calling the same person six times in the same day will only end up making you feel worse. Maybe take a hot shower, a nap, read a new book, focus on something that will help get your mind off the stress of it and then maybe once you've stopped thinking about it the call will finally come. I'd say if you're still not hearing things maybe by the end of the week/early next week I would call again and try and get a different representative who I will approach calmly but make sure that they know I expect a response even if it's just an update.

Maybe it will set things back a little bit, but at least you are getting approved and the surgery is going to happen in due time. If it's a little closer to Christmas than expected, maybe you can help out in other ways. Even if the surgery is in November you may still be well enough to help hang lights and whatnot as long as you're mindful of letting your body rest.

Either way, I will keep my fingers crossed for you that your answer will come soon =)

[barbi1281 112]

I appreciate everyone's response. I wish I could go there in person but due to helping with my mother's disability, I only have sick leave available so every time I take off for personal time, it's without pay now...

I hear you Izuri but the problem is that they are not communicating with me at all. I've contacted my insurance and nothing has been submitted (and nothing can be submitted without a date on it). I'm not waiting on the insurance company - I understand that part... I worked for United Healthcare for 5 years... I'm waiting on my surgeons staff to submit my package which is complete to the insurance and is simply being sat on for no reason. Also, what makes it even more stressful for me is that I have a demanding job (I'm young and high level - aka a lot of responsibilities and no excuses accepted) and in any given month there are only two weeks that I can have this surgery done - the second week of the month or the last week...

Also, for us Christmas is more than just decorating... I, by myself, cook Christmas dinner for my entire family - everyone comes to my house... this has been tradition every year for 10 years. Most of our family does not know I'm having this surgery and as far as everyone knows I'm still cooking... I cook for two days... I'm concerned about being well enough to do that. Not to mention both of my children have birthdays within a week of Christmas...

Point is that I busted my tail to get things done b/c my doc told me if I did, I could have my surgery at the end of September and then his staff sits on my paperwork and delays me until who knows when...

[Oregondaisy 2,021]

I totally understand your frustration.

Since Christmas is such a big deal for you and your family, and most of your family does not know you're having this surgery, it may be time to start suggesting that other people bring dishes to share. There is a good chance you'll be on a post op diet, and you're not going to want to sit down for a huge meal that you have cooked and will not be able to eat.

Start paving the way now, that things are not going to be exactly the same this Christmas!