Not getting a clear answer

[Laura Lopez 20]

Yesterday I had my last appointment with my surgeon but I was advised a week ago that my insurance (medical) has new guidelines that require 2years of dietary notes (it used to be 6 months). The girl at the front desk said maybe if I keep going for another year that should suffice the requirements. When I met with the surgeon I mentioned to him that I was a bit upset that now I must wait longer, he looked a bit confused and checked my record and said I am sure we can submit next month. So Who is right? It is hard when I keep hear two different things.

[SusanB55 89]

Pffffft. What insurance do you have? Call the insurance yourself and/or look it up in your benefits book. The insurance staff at my office messed up on my husbands appts so I had to raise a stink about it. Ended up we submitted his case with only 2 NUT appts instead of 3 required.

[KristenLe 5,979]

You should ask your insurance for specific requirements in writing. I was told verbally one thing and found out different at my last Nutritionist appt.

[Laura Lopez 20]

SusanB55 I have medical ( Preferred IPA of California through LA Care) I have called both LA care, and IPA and both said that they weren't allowed to give me any information over the phone, that I should be contacting my Drs office. I feel like I am going in circles.

Edited May 18, 2016 by Laura Lopez

[SusanB55 89]

@@Laura Lopez I've never heard of that insurance but even more importantly, I've never heard of an insurance company NOT giving you your benefits. I would call them back and ask for the supervisor. If she tells you the same thing, ask who CAN give you the benefits. Something doesn't smell right!

[KristenLe 5,979]

I was told something similar by BCBS - Told me my Dr would need to determine requirements for prior authorization. I could not get anything in writing other than coverage info.

[Read2016 658]

Which BCBS was this?

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[SusanB55 89]

I was told something similar by BCBS - Told me my Dr would need to determine requirements for prior authorization. I could not get anything in writing other than coverage info.

Seriously??? OMG, that's utterly ridiculous! I called several times to BCBS AZ (Fed plan) and was treated so well and all my questions were answered. Yes, they had their requirements and the surgeon had his, but they should still quote benefits. I did medical billing for 13 years and this is the norm!

[KristenLe 5,979]

I'm in Medical adminstration too and was quote annoyed. I even asked our benefits coordinator to try and get it and she was given the general policy info. It's BCBS of RI.

[Read2016 658]

Hmm wonder it's similar to empire BCBS of ny

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[SusanB55 89]

I'm in Medical adminstration too and was quote annoyed. I even asked our benefits coordinator to try and get it and she was given the general policy info. It's BCBS of RI.

AAAgh! I would have been spitting fire! That is a terrible policy!

[KristenLe 5,979]

When I initially called - they reluctantly listed info over the phone. One requirement was 6 months of supervised weight loss. I wanted clarification on that (since coworker with same insurance didn't require that). I was told I would have to find out requirements from surgeon when they request prior authorization. Surgeons office told me 6 months weren't required (on my 2nd monthly visit). I wish I had that info in March - I may have had surgery already.

[Read2016 658]

My guess is if the surgeon says you don't or do need something, the insurance has to go with it. The surgeon is suppose to be the medical expert

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[Anna Nim 196]

I'd think you would be grandfather'd to what the bennies where when you started.

Two years is crazy!

[Laura Lopez 20]

When I initially called - they reluctantly listed info over the phone. One requirement was 6 months of supervised weight loss. I wanted clarification on that (since coworker with same insurance didn't require that). I was told I would have to find out requirements from surgeon when they request prior authorization. Surgeons office told me 6 months weren't required (on my 2nd monthly visit). I wish I had that info in March - I may have had surgery already.

Initially I was told all I needed is my 2 year weight record. 6 months of dietary notes, NUT and psychological evaluation. Which I have done all I even provided them with a 3 year weight record. My next appointment is June 30th I am hoping it goes just the way the surgeon said and they submit to my insurance then.

When I initially called - they reluctantly listed info over the phone. One requirement was 6 months of supervised weight loss. I wanted clarification on that (since coworker with same insurance didn't require that). I was told I would have to find out requirements from surgeon when they request prior authorization. Surgeons office told me 6 months weren't required (on my 2nd monthly visit). I wish I had that info in March - I may have had surgery already.

Initially I was told all I needed is my 2 year weight record. 6 months of dietary notes, NUT and psychological evaluation. Which I have done all I even provided them with a 3 year weight record. My next appointment is June 30th I am hoping it goes just the way the surgeon said and they submit to my insurance then.