Rejected again!

[clickersister 0]

Well, I was just rejected for the second time. The rejection letter said that I met all of the requirements, but other options had not been pursued. I'm thinking that my surgeon's office knew both times of more things that should be done but chose to take my money for extra office visits instead of telling me what I might do to be approved. The more rejections.....the more money for them. So I will be changing surgeons and trying again.

[crzytchr 3]

Other options pursued....did you ask what they meant by that? They may expect you to follow a dr followed diet program, or an exercise program that is documented. Call the insurance company and ask. It may not be the surgeon's office.

[clickersister 0]

No, I've done all that. I've been jumping through hoops for the insurance company for 20 months. I feel like the surgeon's office has had knowledge of little things (a simple blood test) that could have been done before they even submitted the information, and for one of the items, the surgeons office had the info and didn't submit it. Also, I was told by their office 3 different dates that the info was submitted......once to my face in the office.....when in reality it was never sent in at all. I'm really frustrated right now and I know that a competitor's office would never have let that happen because my niece went through them, and they review the criteria and make sure it's ready to be accepted before it's submitted, then on the chance that it might be rejected, they have special people on staff to file an appeal. My surgeon's office has basically shrugged their shoulders and given me the impression of "Tough luck" and left me to flounder. That's not a very comfortable feeling when you don't feel like they're looking out for your best interests. Sorry, just had to vent.

[crzytchr 3]

Run fast to the other surgeon. This is YOUR money being spent, even if insurance DOES cover it. You have a copay or deductible and someone doing a better job for you deserves the money.

[clickersister 0]

Just an update......not once in 9 weeks did my surgeon's office call to follow up on the insurance process, and since I've received my copy of the rejection letter that was sent to their office (6 days) they haven't even called me to notify me or to follow up on it. Oh, and I forgot to mention that they have tried twice to bill me for office visits that were already paid for! I had proof that they were paid!

Needless to say, I have already scheduled my appointment with a new surgeon. My only issue with this is that he will probably try to talk me into the RNY. It's not what I want, but at this point I will probably do whatever the insurance company allows. I can't spend another year at this weight..................

[crzytchr 3]

Good Luck again! Yeah, don't let him talk you into a surgery you are certain you don't want. I was fortunate to have a great case manager at my surgeon's office. Everything was in and approved in less than a week.

[eesdrop 0]

GIVE IT UP!!! The insurance companies will only jack you around as long as they can. You can fly to Mexico, pay $6500, and be done with it. My band was done in July with Dr. Contreras in Tijuana. I could not get insurance to pay for it and the US Dr's wanted my first born child!! Wishing you best of luck....

[Sooner 0]

It may not be the surgeon but rather, his office staff. A month after I had my office visit and was accepted as a patient, I called my insurance company's referral office and asked if they had received a request. They had not. I called the surgeon's office and talked to their referral coordinator who said "I'm too busy to submit requests to Cigna. They never, ever approve the surgery without several appeals from our office."

After talking to the practice manager, the request was submitted (and hopefully the referral coordinator got an attitude adjustment). As predicted, Cigna denied the request even though I had letters from 3 doctors (endocrinologist, pulmonologist, and primary care) and a total of 150 pages of documentation from these doctors. a Cigna DOCTOR denied me because he said there was no cause and effect between my weight and high blood pressure, diabetes, GERD, and the need for C-pap!!! I was also told they didn't approve the surgery for people with BMIs under 40 even though the policy states differently (my BMI was 34).

The practice manager connected me with the Obesity Law and Advocacy Group at Obesity Law and Advocacy Center. They took my case, submitted an appeal a month later and I had Cigna's approval for the surgery within 30 days! They were free and only need me to complete an application form and get the documentation from the surgeon's office.:tongue:

Hopefully the law firm can help you out. Best wishes - don't give up.

[MiniBand 0]

That's what I am attempting to do right now. I wish you all the best.

[DareCain 0]

I'm sorry. I too am having difficulties getting my own doctor to submit a claim. she's not lap-band friendly and thinks a good ol' diet will get me up and going again. I'm curious--did you go to your PCP or did you go to the actual lap band surgeon? Can surgeons submit a claim for you, or do you have to go thru your primary care provider? Keep your head up and keep trying!!

[nicole242 0]

Funny.... I have called my surgeon's office 2 time now asking what else I need before they can send the information to my insurance company, once they said so-in -so will call you back, she nevre did that last Tuesday when I called they told me to call back on friday because that is tha day they do their insurance stuff, when I call to ask questions the gal seems unsure of the information she is giving me. I think a good part of the process is how well it is presented to the insurance company as well as how confident they are in the information they are giving you. ........ thanks for thr post it gives me something to think about.

[Sooner 0]

I went directly to the surgeon to determine if he would accept me as a patient. Once he did, I went to my PCP and asked him to mail my records and a lettermof support to the surgeon. The surgeon's office collected all the information and sent it on to the insurance company for certification.