Vent: can't stand the run around

[flmama 105]

So my insurance company TPA has verified benefits and coverage and requirements to me directly. I talked to the surgeon's office and they said they had to wait until after the first of the year to verify that information before they could schedule an appt. Fine.

I called and gave them the info on 1/2. I called back the next week and they said it usually takes them two weeks to hear back and verify, okay fine. I'll call back when two weeks passes if I haven't heard anything.

So I call this morning after hearing nothing, and the receptionist says "oh let me check...no, nothing in your file, we haven't heard back from your insurance company." What? So I get on the phone with the insurance company, this isn't acceptable. The rep from the insurance company says they haven't no contact on file from the surgeon...either by phone, fax or email...and wants to know if I gave them a copy of my plan doc which says that it is covered. She is super helpful and keeps me on hold while she calls the surgeon's office on my behalf to find out what they need and if she can verify for them on the phone.

Turns out, now they're changing their story and it's "WE are so busy, it takes US at least two weeks to verify...and we promise you'll hear back from us within another week...maybe."

I get it, I know they're busy. The hospital is a COE, the surgeon is an SOE...it's the first of the year...but it's pretty stinky that the receptionist would mislead me that way, if not flat out lie. I asked to speak to the coordinator and I couldn't get past her at all. I guess I get to have a discussion with the office manager once I finally get an appointment. I don't mind the wait, I just can't stand getting the run around when they could have easily said that they are busy and it takes them some time to get it all done.

Sorry for the vent...just had to get it off my chest!

[flmama 105]

My initial surgeon was much more helpful...but wasn't a SOE and doesn't operate at a COE, so I changed. I'm wondering if I'm going to regret it.

[nygurl 72]

I'm already starting to feel the same way. I've decided nobody is going to feel this is as important as I do- so I'm not letting it slip through the cracks anywhere. I talked with my insurance (BCN of MI) first, got some vauge details and mostly brushed off- went to see my primary care doc, and went over more info with her- got a referral to the gastric doctor's office- called and they said I needed to attend a saminar, which was about 2 weeks away- I waited and attended the seminar on 1/15. Durin the seminar they said we'll take your info and run it through the insurance, to see if it's covered... it takes about a week, then we can set up an initial consult directly with the surgeon. I called the day after the seminar wanting to set up the direct consult, left a message, no call back. Called again today and got an actual person to answer the phone- she said- they don't do the initial consult until they know my insurance will cover it. I explained, my insurance is based off of current BMI, and how will they submit my info if they've never met with me? She asked me for "approximate height/weight", which I gave her- she then said- oh well, you'll need 6 mo of diet logged with your doctor, that's your next step- I said I have two years worth- gave them my dr's #, she said she'd call my doc right away and get the form faxed over for them to fill out showing this diet routine and then they'd call back and make my initial appt. I plan on calling my PCP this afternoon to notify them of the paperwork coming over and making sure it's filled out and faxed back asap.

Hopefully I can stay on top of it without becoming a bother to everyone else, but reality is- this is important enough to me to make sure everyone else is doing their job.

Just stay on top of them, and keep following up

best of luck- hoping that you'll have a quick resolve and get in to your surgeon soon!!!