Surgeon Submission to Insurance Delays

[ryanadam 1]

Hi Everyone! Long time lurker, first time poster.

I just finished my medically supervised weight loss (along with the other insurance requirements) one week ago. I called to check with my surgeons/doctor's office to see if they submitted my pre-certification to my insurance. The lady was pretty rude to me and said she's a little behind and it would get submitted within 3-4 weeks.

Is this normal?

I don't see how it would be difficult to put the stuff together and fax it. I have Aetna and they have 4 requirements:

1. Proof of BMI over 40,

2. history of high BMI,

3. Psych Eval

4. medically supervised weight loss.

My primary care doc took care of the first 2 things, the psych eval was nice and easy and the psych's report was sent to them months ago. So the only thing they need to do is put together some info about the med supervised weight loss. Seems like it shouldn't take more than a few days.

Am I missing anything, or did anyone else have this issue? I'm going out of state for my surgery at Banner Gateway in Gilbert, AZ

[ShrinkingPeach 1,291]

My surgeon's office dropped the ball and didn't send my info when they said they had. Call and speak to the practice administrator and ask for assistance. Good luck!

[shellyd88 463]

I've seen many people saying this has happened to them as well I had some difficulty as well seems like they are very slow in getting things rolling and staying organized my issue was get this that or the other test or records from any Drs u see etc and it seemed they never " received" faxes so I got really sick of the BS so I went to each dr got my records and asked for copy's all reports tests CDs of any X-rays ultrasounds etc anything I had to get done I never gave them the only copy's of anything always had my own copy's I also made sure I brought with me to hospital the day of surgery a copy of everything in case they said oh we don't have this or that and it actually happened they said I didn't take the correct dosage of blood thinners etc I said ughh yes I did here's my receipt here's a photo of the bottle where's the lab I'll go tested right now well they decided it wasn't necessary I swear I think they slow things down on purpose they either overbook or can't for some reason get their shit together I work with attorneys so I have some experience with BS and their lack of focus and organization also time management makes one wonder how they ever got a law degree lol

[PlBren 21]

3 to 4 weeks? That is crazy! I thought it was bad when my doctors office took 11 days to submit. Maybe you should call your surgeon directly, explain that if they are too busy to file paperwork that you would like to come in, get a copy of your complete file so that you can either file it to the insurance company yourself or go to a different surgeon and have them do the surgery and file the paperwork. If you talk to the surgeon directly - that may help. They may not realize how backed up this one person is.

[ryanadam 1]

Thank you for all the advice!

@@PlBren I will ask to speak with the surgeon, He is awesome, so maybe he has more influence.

I'm going to call today and see what I can make happen. I purposely chose a larger hospital network because I thought they would be on top of everything... urg.

With the work plans I have later this year, taking time of for surgery/recovery will be impossible until Feb 2016. I really don't want to push it back that far.

I'll let everyone know how this turns out.

Edited August 21, 2015 by ryanadam

[ryanadam 1]

@@PlBren you are a genius!!!! I spoke with the surgeon and he put in contact with a coordinator that is going to submit my pre-certify stuff to the insurance TODAY! Thanks!

If you are running into this problem too - take that advice, contact the surgeon. After all, that's how they make their $$$ money.

[PlBren 21]

@@PlBren you are a genius!!!! I spoke with the surgeon and he put in contact with a coordinator that is going to submit my pre-certify stuff to the insurance TODAY! Thanks!

If you are running into this problem too - take that advice, contact the surgeon. After all, that's how they make their $$$ money.

So good that worked for you! Good luck with the insurance stuff!!