Need Your Opinions...behavioral Health Issues From Stalking Insurance? Lol Not Quite

[FDclerical 318]

i posted this in my blog and i got a few replies. i realize this is probably a better place for it. i love the comments i received but every since Friday its all Ive been thinking about. anyone else have thoughts on this???

i need to get this ALL out before i insane. or i guess to prove that im NOT insane. nor do i have BEHAVIORAL ISSUE. lol i cant believe this. UGH anyways. lets start from September 5th.

September 5th was the last day of my 6 month NUT visits. completed and faxed over to my Surgeons office the same morning.

September 6th. I gave it a day and didnt call them. They received my paperwork but again i never called the Surgeons office because I was told my paperwork was complete and would be given to Kathy our Surgical Coordinator. In my mind i assumed everything was fine due to the fact that the notes in my file say i chose to go with the gastric sleeeve. I had also met with my Surgeon a month before making my final decision and he specifically said lap band would be a waste of time and probably have to be removed a year later due to all complications and issues. (plus i have a 2 year old and all the fills wouldnt be logical with my schedule.)

moving on.....i gave in and called the insurance directly because i was told that i would be submitted. not until the end of the business day did the say that got a call from my Surgeons office questioning authorization code something along those lines.

so i called my surgeons office and spoke with one of his nurses and advised what surgery i wanted and got transferred to voicemail. one of them call me back i think it was on the 10th. One of the nurses called me and said she needed to speak with the Surgeon and she was out of office for one day. they prolonged this all week and then i didnt find out until thursday the 13th that the coordinator ended up back with my chart NOT sure why but basically it had to be inter officed through the carrier to be present for my appointment on the 17th. so again no submittance to insurance.

Monday my appointment with my Surgeon was effective but short. The coordinator DID explain to me that she will not be submitting to insurance until after Monday AND that my Surgeon cannot schedule my pre op or surgery date until approval has been received, I TOTALLY UNDERSTOOD THIS. there was a handwritten note on my flie and my SURGEON took it upon himself to call the Coordinator while we were in our appointment. he fought for the push and understood that its not good practice to get the patients hope up and then be denied for some reason. I called the coordinator to explain to her that i FULLY understood but that My surgeon insisted on calling her. he took it upon himself to question and fight for me. SORRY cant control that

so basically that was that. i was told my chart would go back and it would be submitted the next day. so instead of bugging the coordinator i called my insurance. just to CHECK. ok great no submission. Wednesday i let it pass. didnt call anyone.

Thursday it is now the 20th and i talk to the coordinator. she says shes working half a day and that my file wont get submited. i hvae to wait for friday or Monday. so based on me i called insurance this morning hoping it would be there. THEY then asked me for her phone number. called her and then she called me.

she expressed that she explained these things to be over and over which i understood but i guess lack of communication from the beginning put me in paranoia and reading the forum just made me in the mind set of CALL CALL CALL.

basically my forms just got SUBMITTED 9-21-12. finally BUT that the entire group at the office has meetings a week and they brought up what if i have behavioral issues. are you serious??? because im anxious about my surgery>>?? because i know your busy but my case has been completed for weeks. because i have a 2 year old and work on a small team at work where our schedules are made waaaaay in advance and i work occassional weekends so its really important to know whats going on. i feel bad and sad that they would think of me this way but i feel like i didnt really do anything worng yeah a little obsessive but all in good reason. i told them that i also need more time to talk to my Surgeon during our appointments because there are things i still want verbal confirmation directly from him. i dont know it makes me feel low but i know in my heart that i DONT have behavioral issues. i was told to deal with the Coordinator only (even tho during this time i was going through an address change and had issues getting my address fixed) it may have seem like i called to check on approval but other things too.

all in all i was told not to raise red flags and if i have anxiety to meet with my dietitian or one of the nurses. sigh. yeah everyone has anxiety im just a working single mom who is anxious to start a new life. sorry but 7 months is gone and im ready. whatever i feel better and now the waiting game really begins.

for whoever reads this or made it to the end seriously am i crazy>???? honestly i know im not AND i see where they are coming from but.....come on.

[Annie B 89]

That is incredibly frustrating! You have to be pro-active or you will be waiting for the forms to be submitted 5 months from now. I'm anticipating having to follow-up on mine as well. Had yours been submitted on any of the days they told you, you wouldn't have had to keep on top of it!!

I wish you the best!

[FDclerical 318]

exactly!! reading the forum and based on the relationship i established with them from the beginning i NEVER thought i would feel like this, or be in this situation. i can at least sleep and rest easy knowing that my paperwork is finally being worked on. but in reality i could have already had a surgery date by now. good luck to you as well and thanks for your response!!

[isajck 229]

I think one thing everyone forgets during this process is....you are not their only patient. The coordinator has many patients they are following on a daily basis, submitting paperwork for and so on. Now add in these are regular people, they run into holidays, take vacation days off, get sick and everything else just like an worker at any other place of employment.

I am often amazed reading posts like this. People calling the office daily trying to rush their approval. A reputable doctor usually will have an equally reputable team surrounding him. They want insurance approvals just like we do but for a different reason - income. They do this on a daily basis, they know what is required of the different insurance companies, they know how long replies take and so on. Trying to rush them will only end up with what you've experienced and that cannot be good.

While anxious to have surgery, I did not hound my doctor's staff for just this reason. Plus I did not want to anger someone and have them drop my case to the back of the line. I'd imagine this probably happens more than we know. Remember in the end, they control when you'll receive a surgery date, not the insurance company.

God luck and I hope it all works out well for you.

[FDclerical 318]

Yup I hear you and I acknowledged that duh I'm not the only patient and still I had everything completed for TWO weeks. In the end I've been submitted finally. My mother works for the State of Connecticut and specializes in behavioral health issues and 100% backs me up. Whatever happens happens. If I'm denied, God has his plan for me and everything happens for a reason! Thanks for your feedback!

Sent from my SCH-R720 using VST

[NDN_RN 527]

Yup I hear you and I acknowledged that duh I'm not the only patient and still I had everything completed for TWO weeks. In the end I've been submitted finally. My mother works for the State of Connecticut and specializes in behavioral health issues and 100% backs me up. Whatever happens happens. If I'm denied' date=' God has his plan for me and everything happens for a reason! Thanks for your feedback!

Sent from my SCH-R720 using VST[/quote']

Good luck Tatylish. I know how offices can get frustrated with what they called " frequent fliers" and have been known to push back files. I did call on the 3rd day, the ins co. It was submitted, but the ins. Co asked for stuff that didn't apply, or they already had. I asked firmly, but politely to speak to a nurse, explained my plight, with sorrow in my voice and was approved immediately. I am not a fan of call, call, call, but you had every right to be concerned.

Just Do It!!!

[NDN_RN 527]

Are you in CT tatylish? Your Mom work at CVH?

Just Do It!!!