Got turned down and you will never believe why

[penman53 493]

After jumping through hoops for my bariatric surgeon, and putting up with constant screw ups on bills for me to get to file with my insurance (even though my doctor is a PPO) I finally got turned down last week why?

My patient advocate failed to look over the PCP letter when it was sent to them, then when all of my required visits with the doctor and nutritionist, the phycologist and exercise physiologist, they (the office staff) failed to proof the letter from my PCP and it had glaring errors the immediately made me ineligable for surgery. My PCP, even though he never asked told Blue Cross that I never exercised or made any attemp to lose weight even though I had a back fusion and had been going through several years of excrutiating pain in standing and walking plus shoulder surgery and a knee that was bone on bone. Plus I had documented 13 visits with a nutritionist since 2010 which included weight loss programs to help me lose the weight on my own.

I can't believe the incompetance of my doctors office staff. There were two times, when the letter arrived and later just before the paperwork was submitted to my insurance carrier. How could they let something like that slip? I am so devastated, I was ready to go on this surgery and fully expected a surgery date of early June and now it could be months later or possibly never.

When I think of all the time, effort and not to mention all the butt time sitting in waiting rooms for the doctor and nutritionist and to have this outcome simply amazes me.

I'm 59 years old, diabetic, BMI of 44, 350 pounds with sleep apnea, hight blood pressure, high chloresteral the works. Not to mention a heart condition. Looks like my goose is cooked.

Please someone tell me what to do to fix this fiasco please????

Mark, Edmond Oklahoma

[nervousnellie 50]

That would be extremely frustrating! I'm so sorry! I guess I was lucky. My doc wrote the letter and let me proof it before they signed it to make sure it had all the information I felt like it needed (it did). Best of luck as you try to get this fixed!

[kulita 243]

Ok Well, Calm down. It happens. In 2005 I was denied then I appeal and was approved only to find out the week prior to surgery I was denied due to recent changes and I no longer qualified. I kept fighting it and in 2013 I was approved and wasted no time in getting my sleeve.

Try to apply again. Do they have an appeal process?

[SHORTDOG 27]

Have your PCP re-write the letter and let you proof read it before anything, then i would "demand" him to make an appeal on your behalf. If he doesn't, then it is way past due for you to look for another PCP and have the process started all over again....frustrating, time consunming, if at first you don't succeed...you know the rest!

Good luck and don't give up! God bless!

[Ms.AntiBand 2,984]

Definitely .. Appeal! Over and over if you must. Insurance companies hate paying, and will do what they can to make you give up. Don't. Keep it up until they give you what you've been paying premiums for. Insurance companies suck and slacker drs are the worst. Have a talk with your dr and make sure he's aware of it. Some drs are in the dark about anything beyond their treatment rooms.

My dr with a prior surgery messed up and when he found out he personally got it approved within a week.

DONT GIVE UP!

[penman53 493]

Ok Well, Calm down. It happens. In 2005 I was denied then I appeal and was approved only to find out the week prior to surgery I was denied due to recent changes and I no longer qualified. I kept fighting it and in 2013 I was approved and wasted no time in getting my sleeve.

Try to apply again. Do they have an appeal process?

Yes they do and I will meet with my Dr. tomorrow to try to straighten this out.