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Frustrated ..upset..insurance

A

Aquajogger

Member
I had hoped to have my surgery already.. Completed all that was required by my insurance company and doctor . Have seen seen dietitian for 3 months, had clearances from my kidney and heart doctors .. Seen the Physiologist.. Evan had my chest X-ray.. Have been waiting , waiting and waiting even longer , for insurance approval. Contacted case manager and told her that I was really getting impatient . I was told approval usually took up to 2 and a half weeks. I have been waiting over a month ..her reply was "I thought we would have heard by now.. " the next day I called my health issuance provider to see what the hold up was.....I was told "we just received a faxed request for approval TODAY!!!!"
I was confused and contacted case manager again. She said after talking to me she contacted insurance provider and they stated they never received the request for approval that ,she said , she sent in early Nov.
She sent in another that day...
Now the doctor will be gone for several weeks, the request for insurance approval is just sent in.. My clearances will be over 6 months old before surgery date . I must start all over with my clearance from heart and kidney doctors , including new EKG...
Nervous enough without this problem .
 
I am sorry this process is taking so long for you and your having to retake some of the tests, stay strong and it will be done before long. :(
 
Thanks for encouraging reply ..

I had my first group session on Jan.3 .2012.. Never expecting to still be going though the process a year later and still no surgery date . Holding off and not making plans because I do not have any idea when surgery will happen. I am starting to think maybe Simething is telling me not to do this!
 
Don't give up the process can be frustrating but, it will be worth it in the end. I went through all of the hoops and at the time of surgery it was postponed until Feb 24th. Good luck with your journey keep us posted.
 
You could try calling the insurance company directly and explain what happened. Ask for someone in charge to talk to. Maybe they could rush things through or relax the 6 month rule. Just try.. and the worse that can happen is it might not help but the best that can happen is maybe someone could help you. It might help to explain that they lost the original fax. GOOD LUCK!
 
First and foremost I would contact the office manger at your surgeons office and enlighten her as to what your patient "advocate" aka case manager has done or not done as the case may be.

I had a similar situation with my first case manager. She was adamant that my insurance co-pay for my surgeon and hospital fees were this ridiculous number, like almost 5 times more than what it actually was, and that my office visit co-pay were 3x's more that it actually was. She was also failing to follow through with obtaining all my medical records, which by the way were very easy to access. My husband is an employee for the hospital system that did my surgery, All of my Dr's are associated and affiliated with the same hospital system which has an interlinked information system that is accessed by computer and WITHOUT an authorization to release.

I finally had a meltdown and contacted the systems patient relations and my surgeons office manager about the goings on and e-mailed both of them the paper trails and e-mails. Needless to say, I was assigned a new advocate / case manager. By this point I had already contacted all of my Dr's managers and explained to them what was going on. Those ladies were awesome. They personally took care of getting my records directly to my Surgeon, the PA and the nurse manager. They then e-mailed copies to my patient advocate aka case manager as follow up. once all of that was taken care of I had my surgery date within a week.
 
Fustrated

Thank you for all replies..
Several things have happened in the last few days.
I contacted my insurance company several days ago , they were reviewing my case... I got an approval TODAY!!!!
I contacted my case manager and her supervisor .. Sent the same letter to both requesting another case manager with the reasons for my request .
I was assigned a new one today!
I do need to have another cardiac clearance and EKG because it will be over 6 months old before I have surgery .. It is one of the surgeons regulations.
My kidney specialist sent in another clearance .
With approval from both my insurances I am covered at almost 100%.
My case manager told me that both the 3 month dietitians nod the physcoligical was self pay.
I had contacted my insurance about that earlier and was told both were covered. I had to pay the physiologist out of pocket because she was "out of network" . But was told to send the information and bill to insurance and they would reimburse me at policy rate ..so better than nothing but I did wish they had a providing physcloigist .
Doctor is away this month . I have an appointment for an EKG next week.. Since we have already made reservations and plans for a early Feb. vacation , I will have my surgery after that.
 
have to ask... Is your original case manager aka advocate named Crystal by chance?

+

My surgeon is out of the Country until January.

Coincidence or irony??

I am very curious because it sounds almost identical to my experience and there cannot be 2 of the same dorks in this world doing the same things...
 
Aquajogger said:
Thank you for all replies..
Several things have happened in the last few days.
I contacted my insurance company several days ago , they were reviewing my case... I got an approval TODAY!!!!
I contacted my case manager and her supervisor .. Sent the same letter to both requesting another case manager with the reasons for my request .
I was assigned a new one today!
I do need to have another cardiac clearance and EKG because it will be over 6 months old before I have surgery .. It is one of the surgeons regulations.
My kidney specialist sent in another clearance .
With approval from both my insurances I am covered at almost 100%.
My case manager told me that both the 3 month dietitians nod the physcoligical was self pay.
I had contacted my insurance about that earlier and was told both were covered. I had to pay the physiologist out of pocket because she was "out of network" . But was told to send the information and bill to insurance and they would reimburse me at policy rate ..so better than nothing but I did wish they had a providing physcloigist .
Doctor is away this month . I have an appointment for an EKG next week.. Since we have already made reservations and plans for a early Feb. vacation , I will have my surgery after that.
Click to expand...

So glad everything is working out! Sorry you have to wait until after February, but the time will fly by I am sure. Just enjoy Christmas and your vacation and be ready for your new beginning after that. :) GOOD LUCK!!!
 
Yay, the sun is shining and everything is good. I had to self-pay for both the psychologist and dietician appointments, even though my insurance paid for most everything else.
 
Well ,I got a new case manager and now the 2 month wait is on. My husband did say he could cancel vacation but that is unfair to him. Getting the surgery done here in Florida because everything I read on the doctor is positive but had all my testing done up north with doctors I have had for years. New to get another clearance and EKG from a heart doctor here because of the length of time since my earlier on. This is due to first case managers delay in doing things.
I guess I waited almost a year and a couple months should go fast with the holidays and vacation. Will see doctor for Pre-op visit and other pre-op stuff right after we return from vacation..
 
I could not understand why, when My insurance required the 3 month dietitian and Physcoligical ,I was told by my casemanagee,they were self pay. I called my health insurance provider and they said they were covered.did pay for Physcoligical since she was out on network.. But reimbursed at health plan rate. I do suggest to check with your insurance company about these.
 
Hello,I'm sorry that its taking so long I hope to know some thing this week when I will be having mine suppose to be in january I'm Having the sleeve,I have had my 4 nutrition visits and psy eval but I'm suppose to have 2 support group visits and that has been difficult so i joined this on line in hopes this will caount as one.
 
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