Ticked off at insurance and Dr.'s office

anonemouse · January 24, 2007

The financial counsellors at my surgeon's office supposedly faxed my paperwork to insurance over two weeks ago. I got an email from Tonya, on of cousellors, saying that they would check every week to see what the progress was. I sent one of them an email on Monday, asking how everything was doing. I got an email today from her. She said that she had called AVMA (the insurance company) today, and they said that everything would have to go to First Health (the underwriter of the policy). So she called First Health and was told that the fax number she had sent everything to was old and that she needed to resubmit.

Um, shouldn't she have found this out when she supposedly called them last week? According to her first email, she was going to call them every week until they made a decision! Not to mention the fact that the financial counsellors apparently don't know what each other is doing. I had gotten an email a couple of days before Tonya's, from another of the counsellors, saying that she had sent everything off and had gotten a confirmation fax from the insurance company!

**LaP HaPPy** · January 24, 2007

I am sorry to hear that you are getting the run around. If I were you, I would call the insurance company directly. Get the name of each person you talk to and keep a journal!!! Take it from me, be pro-active and organized!!! Good luck to you!

niki

demsvmejm · January 25, 2007

Sorry for your insurance complications!

I called my insurance (BC/BS of Michigan) and gave them all the codes the Dr. office gave me regarding the procedure. They said they cover all of these codes. With a weight of 100 lbs overweight and Dr. note saying 1 yr of trying dieting. I called my surgeon and asked if she submitted my pre-approval info to the Ins. yet. She said since I called and they approve this procedure, that she didn't have to.??? I really would like to know upfront if there will be any surprises. She I insist they submit pre-approval papers?

terrriho · January 25, 2007

laurend,

I agree with niki, at least my experience seems to suggest you should call the insurance company directly and often. Today, I called my insurance company and found out that finally they had an answer and it was for approval (WOOHOO):clap2: . This is the end of a 4 1/2 month journey where I found out that my information did not move to the next point in the system unless I called them and asked. I literally walked it through their internal routing system (and that is pretty hard since I live in Montana and they are on the east coast). Nobody has your best interests at heart like you do, get involved and be informed. Call the insurance company, find out what they have and what they need. Keep a record of each call, date, time, whom you talked to, what they told you and what you told them. Each time you call reference your last call (or other call) by naming whom you talked to, what you talked about, what action they promised and then pose your request/question. It will get their attention, keep you organized and on top of things. Good Luck

Good Journey,

Terri

barbara465 · January 25, 2007

Most insurance companies send a letter of approval - to the doctor and the patient. Most doctors won't move forward without that approval. I would make sure the doctor's office has received approval. I would also check with the insurance to make sure a. you are covered, and b. they have sent approval to the doctor's office.

Most of the doctor's offices are busy and sometimes the follow up falls through the cracks. We end up having to keep them communicating. I got my approvals, but I see that 7 months later they haven't paid the surgery center. :rolleyes:

anonemouse · January 25, 2007

Keep a record of each call, date, time, whom you talked to, what they told you and what you told them.

One of the problems is that when I've called, I keep getting transferred between the insurance company and the underwriter, and neither knows what the other is doing. I don't know which one is responsible for doing certain steps, and the insurance company and underwriter both claim that the other is responsible.

terrriho · January 26, 2007

Lauren,

I am sorry for your situation and I am sorry I really can't be of more help. I am not a professional, I can only speak to my personal experience here. My surgeon's office was pretty good about advising me as to what should/would happen so you might want to go talk to them (I know you are not thinking too kindly of them right now but they may have the key here). They may have had to deal with your type of situation before so they can tell you who should be responsible. Another suggestion is to ask both the insurance company and the underwriter what they are responsible for rather than letting them tell you what they aren't responsible for. It is easy to deny knowlege, a little harder to deny what you do. You also might want to check out the Bandsters Insurance group at Yahoo as they have a database of info and they have more knowledgeable people than me there. (I joined when I could see I was going to have a problem with my insurance.) Again, good luck.

Good Journey,

Terri