Bad news from my surgeon re: insurance. SO SAD.

[MissMe27 0]

I posted this on another forum before I realized this forum was available... please read:

I believe I met the surgeon that was to perform the Lap-band on me back in October of 2008. Since then I have met with all kinds of specialists for approval of the surgery. I had a sleep test done at the hospital. My insurance, Blue Cross Blue Shield IL - HMO had approved everything... I have/had an appointment scheduled with the surgeon for this coming Friday and I just called to confirm that they had all the evaluations needed so that when I met with the surgeon again we could take the next step which I understood was to schedule the surgery. Well the nurse informed me that due to contract negotiations the insurance has cancelled all surgeries. I have to wait AT LEAST 2 months.... but maybe more. She said another option could be to go back to my primary care doctor and have him refer me to another surgeon at a different hospital since the one I was seeing is the only one covered by my insurance at that hospital.

Should I call the insurance and see what they say?

Should I go see my primary care doctor?

I'm so sad. I am so ready for it now. :thumbup:

[babbs3772 1]

I would do everything and everything! Call your insurance, call your pcp - do not give up! I was denied twice so I do understand the frustration, Good luck to you and I think good thoughts for you!

[susan1961 0]

You shouldn't even have to see your PCP again, or repeat anything you've done. Just call your PCP's office and tell them you need a new referral to a surgeon who is in your network and operates at a hospital with which your insurance has a relationship. Might help to call the insurance company in advance and find out which ones qualify. You will want to be sure that the anesthesiologist who supports your surgery is also in network so there are no surprises.

This doesn't have to hold you up all that much, though changing horses midstream is rough.

[HeatherO 7]

I agree with Susan1961. If you have already jumped through the hoops and have a tentative approval with the insurance company, switching doctors should not be as difficult as much as nerve-wracking.

You could always wait two more months - but there is no guarantee that it will be resolved in two months, perhaps it may take even longer.

I would keep the ball rolling in multiple directions. Seek another referral, get a consult with a different surgeon who has a good record and see who can schedule your first that you feel comfortable with.

[MissMe27 0]

Thanks ladies...I called the insurance and they said its not up to them, that the negotiations the surgeon was talking about are between him and the medical group (my hospital... I have an HMO)... so fine. I called the medical group and they have no idea how long these negotiations will take so the suggested I call my PCP and have him refer me to another sugeon. What a pain in the butt. But I'm totally on it. I'm waiting to hear back from my doctor's office.