Blue Shield CA and the insurance update

[2goldengirl 2,076]

First, I'd contact your medical group and complain about this little obstructionist. Every medical group has people who work exclusively with medical offices on issues and you may well be able to get somewhere that way. If that doesn't work, it's Grievance time.

[Shanni1269 73]

Well...suprise she called me this morning and was rude it took all I had to ask my questions. So they wont submit to insurance until ALL requirements are met even though 4 of the 6 requirements are surgeon requirements not insurance requirements. whatever...im sure she will mess up my insurance submission just to keep me from getting my surgery even longer.

Its sad that I feel that way towards what should be a medical professional.

Maybe its time to switch...I dont need to fell uneasy for such a big decision I am making in my life..and I already have to fight insurance...I shouldnt have to fight dr office too

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Edited March 23, 2016 by Shanni1269

[2goldengirl 2,076]

I'd go ahead and file that Grievance. It IS true, however, that most surgeons won't submit for approval until you meet requirements, including their own requirements. Good luck!

Edited March 23, 2016 by 2goldengirl

[Shanni1269 73]

I know they want all the requirements completed so they can submit to insurance with the best possible outcome....however, I do not have faith that this particular person will be putting in much effort on my account

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[Soon2BHealthyAggie 23]

I had a similar issue with my coordinator. I had to file a complaint with the office manager. After that, she was sweet at pie to me. I would definitely talk to someone over her about her attitude and ask them the 3 month question

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[reachbree 140]

THIS right here, is exactly my same situation. Seems like they even have an attitude about it. I have 1 more NUT visit to fulfill my surgeons office 3 months requirement then we will submit, all while they are shaking their heads at me saying "Its 6 months"......

So the insurance coordinator finally received the right information regarding my insurance but now says they are going to use the recommended 3 months from initial consultation before sending approval anyways. The surgeon said NOTHING about that. He said if my insurance didn't require weight checks I could be ready in a matter of a couple months. I think she is punishing me for knowing more about my own insurance than she did and I was persistent in getting the information to her.

I need to call the office to clarify but I am so angry I am afraid I am going to say something that will just piss her off and she will prolong my process even more. I really like this surgeon but do not know if I can deal with this person.

[Shanni1269 73]

its ridiculous thatbthey can be so rude...this is already a tough process for us and now we have to fight them too

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[reachbree 140]

So do you have to start your 3 months or did already during this battle?

My surgeons office require 3 months anyway as well so im coming up on that last month.

Through this process The first few reps I spoke with from BSCA all said 6 months is required. I got a good push from this forum to not give up until I get the CORRECT infO. I called bsca and finally got someone who informed me that the policy DID in fact changed and there is no 6 month requirement. Unfortunately i didnt get someone who was willing to contact my surgeons office to tell them that. So I supplied surgeons office with a copy of the UPDATED Policy and auth form and they looked it over and STILL insisted on the old policy requirements..they got tired of hearing me say "that is not the updated policy requirements" so now theyve agreed to let me complete the 3 mo then submit.

Seems as tho all the staff at my office have attitude issues..major. I realize they are not there to be my friend but they can be a little kinder. ..they have ALL had a type of bariatric surgery and if bariatric surgery makes you such an angry person im not sure I want to go through with it. Funny becuase the surgeon, whom by the way did NOT have bariatric surgery is very kind or atleast normal!!!

I hope the remainder of your process is smooth as butter!

[Shanni1269 73]

I was still doing monthly visits while i fought with the surgeons office so I just finished my 3rd month. niw they screwed up the submission for authorization.

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[2goldengirl 2,076]

I was still doing monthly visits while i fought with the surgeons office so I just finished my 3rd month. niw they screwed up the submission for authorization.

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Time to switch offices, then. Dr. Chin's office wouldn't believe me about the change in policy. You can also call Barbara at JMPN, she processes the auths and she knows about the change.

[Shanni1269 73]

It may just be. I just fear having to start over

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[2goldengirl 2,076]

BTW, your surgeon may require three months, but the three months "suggested" by the Blue Shield policy is only to make time for preop workups. It took that long for me to get the GI consult, EGD, and sleep study my surgeon required.

Believe me when I tell you, if Blue Shield "required" anything, it would be stated that way in the policy.

My surgeon's office actually had some knucklehead from Blue Shield Provider line try to tell her "there is no medical policy for bariatric surgery". She said "Really? Then what is this that I'm looking at online right now?". Yeah. That led to a call with a supervisor and some retraining. People go off cheat sheets on their desk instead of looking up the flippin' policy. Grr.

[Shanni1269 73]

I know I had called and got 4 different answers. I made them pull up the policy and laugged as they read it to me only to tell me what I already know. Didnt matter my surgeons office says if it says 3 months is recommended the we are going to require it. Now they have an incomplete insurance auth submission claiming they are waiting on a report from a biopsy i didnt have because everything looked good during my endoscopy.. he didnt want to take a sample if nothing looked off.

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