Guest guest Posted December 1, 2006 Report Share Posted December 1, 2006 Cat that is why I was self pay. BUT look at it this way, in the end when all is said and you are post op, you will be " paid " $20-$30,000 for all of your work!! : ) Everything happens for a reason. KEEP PLUGING AWAY. BE FIRM. BE POLITE. DO NOT GIVE UP. BREATH. : ) Lap VG 8/1/05 286/190/145 " I'm hungry " Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 1, 2006 Report Share Posted December 1, 2006 Uniited must be able to memo or such - I would get something in writing. How frustrating it must be for you... Jackie in CA baricat baricat@...> wrote: I've done my investigative research. I finally decided on which surgeon. I have spent untold hours on the phone with the insurance company, who informed me that pending a clinical review, this surgery was covered 100% with no exclusions. So this afternoon, I get a call from the surgeon's office that they called United and were told that this surgery IS EXLUDED. They said I needed to take it up with United if I disagreed, and they would not go forth without proof of no exclusion. I spent an hour on the phone with United this afternoon, getting it all documented that THERE IS NO EXCLUSION FOR THE GASTRIC BYPASS SURGERY. Try to get back to the surgeon's office, but only get the answering machine. Left a message to call me back. I explained that I really hoped they could figure this out today, since I'll be anxious all weekend about this. No call. So I called United back to ask if they could fax acknowledgement of coverage to the surgeon's office. Once again, I get a bubblehead telling me I'm excluded. Spent another half hour on the phone with the Rapid Resolution Center that determines (for the umpteenth time) that yes, I AM covered. Called the surgeon's office to give them a more direct number upon which they can check, and they've gone home for the weekend, a half hour earlier than the opening announcement on their phone says they close. UGH!!!!!! Is it always this tough?? I've done my homework, have all my ducks in a row, then some bimbo gets it wrong and I have to suffer the consequences. At this rate I may not make it to surgery!! --Cat We are a very active support group. If the email becomes overwhelming, please change your setting to NO EMAIL! Please contact Group Creator Robyn@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 1, 2006 Report Share Posted December 1, 2006 I would be really unhappy with whomever is giving you the run around, but unfortunately when you are dealing with insurance companies, this is what you run into. Lhsh@... American by birth, Saved by the grace of God. I Need To Vent!! I've done my investigative research. I finally decided on which surgeon. I have spent untold hours on the phone with the insurance company, who informed me that pending a clinical review, this surgery was covered 100% with no exclusions. So this afternoon, I get a call from the surgeon's office that they called United and were told that this surgery IS EXLUDED. They said I needed to take it up with United if I disagreed, and they would not go forth without proof of no exclusion. I spent an hour on the phone with United this afternoon, getting it all documented that THERE IS NO EXCLUSION FOR THE GASTRIC BYPASS SURGERY. Try to get back to the surgeon's office, but only get the answering machine. Left a message to call me back. I explained that I really hoped they could figure this out today, since I'll be anxious all weekend about this. No call. So I called United back to ask if they could fax acknowledgement of coverage to the surgeon's office. Once again, I get a bubblehead telling me I'm excluded. Spent another half hour on the phone with the Rapid Resolution Center that determines (for the umpteenth time) that yes, I AM covered. Called the surgeon's office to give them a more direct number upon which they can check, and they've gone home for the weekend, a half hour earlier than the opening announcement on their phone says they close. UGH!!!!!! Is it always this tough?? I've done my homework, have all my ducks in a row, then some bimbo gets it wrong and I have to suffer the consequences. At this rate I may not make it to surgery!! --Cat We are a very active support group. If the email becomes overwhelming, please change your setting to NO EMAIL! Please contact Group Creator Robyn@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 1, 2006 Report Share Posted December 1, 2006 --- and they wonder why people flip out.. nerve racking i know. hang tight c ya donna In GastricBypass- LOSERS , " baricat " wrote: > > I've done my investigative research. I finally decided on which > surgeon. I have spent untold hours on the phone with the insurance > company, who informed me that pending a clinical review, this surgery > was covered 100% with no exclusions. > > So this afternoon, I get a call from the surgeon's office that they > called United and were told that this surgery IS EXLUDED. They said I > needed to take it up with United if I disagreed, and they would not go > forth without proof of no exclusion. > > I spent an hour on the phone with United this afternoon, getting it > all documented that THERE IS NO EXCLUSION FOR THE GASTRIC BYPASS SURGERY. > > Try to get back to the surgeon's office, but only get the answering > machine. Left a message to call me back. I explained that I really > hoped they could figure this out today, since I'll be anxious all > weekend about this. > > No call. > > So I called United back to ask if they could fax acknowledgement of > coverage to the surgeon's office. Once again, I get a bubblehead > telling me I'm excluded. Spent another half hour on the phone with the > Rapid Resolution Center that determines (for the umpteenth time) that > yes, I AM covered. > > Called the surgeon's office to give them a more direct number upon > which they can check, and they've gone home for the weekend, a half > hour earlier than the opening announcement on their phone says they close. > > UGH!!!!!! Is it always this tough?? I've done my homework, have all my > ducks in a row, then some bimbo gets it wrong and I have to suffer the > consequences. At this rate I may not make it to surgery!! > > --Cat > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 1, 2006 Report Share Posted December 1, 2006 , that's a really positive way to look at it. I will, indeed, keep plugging away at it. It's just so frustrating that United refuses to call the surgeon's office or fax them, so each time that the surgeon's office calls, I run the risk that they'll hook up with some idiot who can't read the notes made by the Resolution Team. I feel like I'm in the looney bin! It remains a mystery why insurance companies a) hire people who can't read and put them on the phone without training and why they are so resistive about paying for this surgery. Imagine how expensive it's going to be to pay for meds, repeated doctor visits and tests, plus inevitable surgeries that result. I'm diabetic, and they spend many thousands of dollars on me in one year with the meds I take, nutritional counseling, the testing supplies, the doctor appts, labs, and other tests every year, plus the high possibility of needing occasional hospital stays for complications. You'd think they'd be smart enough to figure out that this will most likely all go away (or be reduced significantly) once surgery is completed. Jackie, thanks for your thoughts, as well. You guys are great! Thank you for making me feel a lot better. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 1, 2006 Report Share Posted December 1, 2006 UGH!!!! Sorry Cat I hope this get resolved for you soon. Hang in there!! HUGS!!! > > I've done my investigative research. I finally decided on which > surgeon. I have spent untold hours on the phone with the insurance > company, who informed me that pending a clinical review, this surgery > was covered 100% with no exclusions. > > So this afternoon, I get a call from the surgeon's office that they > called United and were told that this surgery IS EXLUDED. They said I > needed to take it up with United if I disagreed, and they would not go > forth without proof of no exclusion. > > I spent an hour on the phone with United this afternoon, getting it > all documented that THERE IS NO EXCLUSION FOR THE GASTRIC BYPASS SURGERY. > > Try to get back to the surgeon's office, but only get the answering > machine. Left a message to call me back. I explained that I really > hoped they could figure this out today, since I'll be anxious all > weekend about this. > > No call. > > So I called United back to ask if they could fax acknowledgement of > coverage to the surgeon's office. Once again, I get a bubblehead > telling me I'm excluded. Spent another half hour on the phone with the > Rapid Resolution Center that determines (for the umpteenth time) that > yes, I AM covered. > > Called the surgeon's office to give them a more direct number upon > which they can check, and they've gone home for the weekend, a half > hour earlier than the opening announcement on their phone says they close. > > UGH!!!!!! Is it always this tough?? I've done my homework, have all my > ducks in a row, then some bimbo gets it wrong and I have to suffer the > consequences. At this rate I may not make it to surgery!! > > --Cat > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 2, 2006 Report Share Posted December 2, 2006 Well welcome to managed healthcare people. This sounds worse in scope than what I've experienced but similar overall. What I've ended up doing is saying, very politely, to the one party (usually the doctor because they're the hardest to get a hold of and it seems so for you) " Could you hold please " and then I call the insurance company and get someone on from them in a 3-way conference call. Now maybe that's hard to do because the doctor's office doesn't want to wait. Well, one, screw them then get a new doctor. Two, maybe you can get a special phone or someone else to get the insurance call rolling while you do the doctor's call and then patch them all in together. I guess the timing and putting one party on hold can be tough but you might be able to pull that off. Once you get what seems to be the correct insurance rep and the ill informed doctor together (or vise versa as my cases have been) it's been my experience that the call lasts a whole five minutes. The content at this point is often filled with acronyms, diagnosis codes, medical terms, and the list of impressive terms is endless. They both conduct themselves very professionally, quickly, deadpanned, etc. Basically NOTHING like when they're " handling " you. It's like a freaking Jekyll and Hyde show. Then it's maybe five minutes of this and they're in a agreement and you're cool. Well, unless your not because the opposing view won out somehow. Regardless, you've got BOTH to AGREE on SOMETHING TOGETHER. You hang up with great satisfaction until a few minutes later when you realize that you pay probably thousands of dollars a year and trust these and others for healthcare where you have to act as a freaking switchboard operator because these idiots don't have the time, inclination or possibly the technical prowess to dial their respective phone numbers. Don't forget the faxing too. I don't know about you but 90% of the time when I ask for a fax I get it and there it is and I read it, possibly file it, act on it, etc. How is it that you, I and a host of others seem to fall into that magical 10% with these jokers where the fax gets lost, garbled, isn't interpreted correctly, gets misfiled, doesn't get sent, someone gets the wrong number, generates more questions, etc.? I mean these people DO use these things a lot right? This isn't the first time an insurance company has faxed a doctor's office or vise versa right? Speaking of that! Are you and I really unique here? I mean maybe that's what's happening. Maybe you and I are the only ones who have a doctor and insurance company that can't get together. Yeah I'll bet that's it. I'll bet if you ask your insurance company or your doctor they'll confirm this by saying, " Yes your situation is unusual, this stuff never happens to anyone else, this is completely foreign to my skill set and daily work, that's why I'm having difficulty assisting you today ma'am. " GIVE ME A BREAK PLEASE! Next time you're suckered into asking someone to fax something to someone else in all of this I'd ask them to fax you their job description. I'd love to see how both the doctor's asst and the customer service asst at the insurance company's jobs compare. I'll bet they're damned near the same and involve crap about helping patients/customers resolve issues. I don't know about you but I'd take those, ask for the day off from work, and just read them over a dozen times wallowing in the irony. Think you touched a nerve? Don't let these SOBs go home another day without doing their jobs and doing them some what well for that one day a year where they might get it right. Listen, I call people all day long on behalf of others who get with me to have me help them accomplish a task, do I really need to pay money to a doctor and insurance company and still do that for myself? What am I paying for again? Oh that's right, healthcare that I'm not rightly receiving, cute. Mike in GR > > I've done my investigative research. I finally decided on which > surgeon. I have spent untold hours on the phone with the insurance > company, who informed me that pending a clinical review, this surgery > was covered 100% with no exclusions. > > So this afternoon, I get a call from the surgeon's office that they > called United and were told that this surgery IS EXLUDED. They said I > needed to take it up with United if I disagreed, and they would not go > forth without proof of no exclusion. > > I spent an hour on the phone with United this afternoon, getting it > all documented that THERE IS NO EXCLUSION FOR THE GASTRIC BYPASS SURGERY. > > Try to get back to the surgeon's office, but only get the answering > machine. Left a message to call me back. I explained that I really > hoped they could figure this out today, since I'll be anxious all > weekend about this. > > No call. > > So I called United back to ask if they could fax acknowledgement of > coverage to the surgeon's office. Once again, I get a bubblehead > telling me I'm excluded. Spent another half hour on the phone with the > Rapid Resolution Center that determines (for the umpteenth time) that > yes, I AM covered. > > Called the surgeon's office to give them a more direct number upon > which they can check, and they've gone home for the weekend, a half > hour earlier than the opening announcement on their phone says they close. > > UGH!!!!!! Is it always this tough?? I've done my homework, have all my > ducks in a row, then some bimbo gets it wrong and I have to suffer the > consequences. At this rate I may not make it to surgery!! > > --Cat > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 2, 2006 Report Share Posted December 2, 2006 Holy freakin' moly, Mike, that was just SOOOO perfect!! I can tell you've got the same sardonic wit that I often get faulted for. It really does blow me away that I'm left here for the weekend to stew in the bomb dropped by other people's ineptitude. I did all the footwork, made it easy, literally BEGGED for a call back before the weekend so I wouldn't have to stress for days. Guess that would have been a big imposition. That 1-2 minutes she might have had to take to call me and reassure me after the clock struck 4 would have been too flippin' much. (That's something I have no patience with. My husband works a minimum of 2 hours extra each day, off the clock, because that's what it takes to get the job done. When I worked, I'd make sure all loose ends were cleaned up before I left, even though I wasn't paid OT. Guess that's gone the way of the horse-and-buggy. That must be why those surgeons get the big buck. So that they can hire idiots who take the first thing that's said to them, even though the patient told you that she had checked multiple times, having been ensured that coverage is clearly in place. She doesn't ask to speak to a supervisor, who could have sorted it out before she made my blood pressure go through the roof. Nope. Just take some office slug's word for it. Way to do that job. I wonder how many times this woman, who works exclusively as a liaison between patients and insurance, has been told something incorrect by the first person who answered the phone at the insurance call center...Hmmmm. Now THAT has never happened before! I'm trying to take this as calmly as I can. I'm trying to look at it philosophically, but whenever I do, I come up with pretty much the same conclusions you came to, which you voiced so eloquently for me. Thanks for at least making me smile about this today, Mike. Much, much appreciated! --Cat Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 2, 2006 Report Share Posted December 2, 2006 I just thought of something....do you get your insurance from work? Maybe the HR department can help you. After all, they too pay for your coverage. Maybe you can see United personally? Jackie in CA baricat baricat@...> wrote: Holy freakin' moly, Mike, that was just SOOOO perfect!! I can tell you've got the same sardonic wit that I often get faulted for. It really does blow me away that I'm left here for the weekend to stew in the bomb dropped by other people's ineptitude. I did all the footwork, made it easy, literally BEGGED for a call back before the weekend so I wouldn't have to stress for days. Guess that would have been a big imposition. That 1-2 minutes she might have had to take to call me and reassure me after the clock struck 4 would have been too flippin' much. (That's something I have no patience with. My husband works a minimum of 2 hours extra each day, off the clock, because that's what it takes to get the job done. When I worked, I'd make sure all loose ends were cleaned up before I left, even though I wasn't paid OT. Guess that's gone the way of the horse-and-buggy. That must be why those surgeons get the big buck. So that they can hire idiots who take the first thing that's said to them, even though the patient told you that she had checked multiple times, having been ensured that coverage is clearly in place. She doesn't ask to speak to a supervisor, who could have sorted it out before she made my blood pressure go through the roof. Nope. Just take some office slug's word for it. Way to do that job. I wonder how many times this woman, who works exclusively as a liaison between patients and insurance, has been told something incorrect by the first person who answered the phone at the insurance call center...Hmmmm. Now THAT has never happened before! I'm trying to take this as calmly as I can. I'm trying to look at it philosophically, but whenever I do, I come up with pretty much the same conclusions you came to, which you voiced so eloquently for me. Thanks for at least making me smile about this today, Mike. Much, much appreciated! --Cat --------------------------------- Everyone is raving about the all-new Yahoo! Mail beta. --------------------------------- Everyone is raving about the all-new Yahoo! Mail beta. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 2, 2006 Report Share Posted December 2, 2006 Cat, Ah you seem to forget that most physicians, surgeons, insurance companies etc. have been forced to cut costs to provide us with such excellent service without increasing our costs. They've had to invest in cheaper phone systems or forego extra features. Their's often don't dial out now a days. Mike > > Holy freakin' moly, Mike, that was just SOOOO perfect!! I can tell > you've got the same sardonic wit that I often get faulted for. > > It really does blow me away that I'm left here for the weekend to stew > in the bomb dropped by other people's ineptitude. I did all the > footwork, made it easy, literally BEGGED for a call back before the > weekend so I wouldn't have to stress for days. Guess that would have > been a big imposition. That 1-2 minutes she might have had to take to > call me and reassure me after the clock struck 4 would have been too > flippin' much. (That's something I have no patience with. My husband > works a minimum of 2 hours extra each day, off the clock, because > that's what it takes to get the job done. When I worked, I'd make sure > all loose ends were cleaned up before I left, even though I wasn't > paid OT. Guess that's gone the way of the horse-and-buggy. > > That must be why those surgeons get the big buck. So that they can > hire idiots who take the first thing that's said to them, even though > the patient told you that she had checked multiple times, having been > ensured that coverage is clearly in place. She doesn't ask to speak to > a supervisor, who could have sorted it out before she made my blood > pressure go through the roof. Nope. Just take some office slug's word > for it. Way to do that job. I wonder how many times this woman, who > works exclusively as a liaison between patients and insurance, has > been told something incorrect by the first person who answered the > phone at the insurance call center...Hmmmm. Now THAT has never > happened before! > > I'm trying to take this as calmly as I can. I'm trying to look at it > philosophically, but whenever I do, I come up with pretty much the > same conclusions you came to, which you voiced so eloquently for me. > > Thanks for at least making me smile about this today, Mike. Much, much > appreciated! > > --Cat > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 2, 2006 Report Share Posted December 2, 2006 While that's a good idea and I like my HR department ya gotta know that they're just another cook in the kitchen that's going to further confuse the issue. Plus, at least at larger companies, they have packets of stuff and 1 800 numbers to various parts of the insurance company they'll give you and THAT IS ABOUT IT. I guess if they can help or you're at your wits end then sure do it. But I'm betting against them helping much/all. Mike in GR > Holy freakin' moly, Mike, that was just SOOOO perfect!! I can tell > you've got the same sardonic wit that I often get faulted for. > > It really does blow me away that I'm left here for the weekend to stew > in the bomb dropped by other people's ineptitude. I did all the > footwork, made it easy, literally BEGGED for a call back before the > weekend so I wouldn't have to stress for days. Guess that would have > been a big imposition. That 1-2 minutes she might have had to take to > call me and reassure me after the clock struck 4 would have been too > flippin' much. (That's something I have no patience with. My husband > works a minimum of 2 hours extra each day, off the clock, because > that's what it takes to get the job done. When I worked, I'd make sure > all loose ends were cleaned up before I left, even though I wasn't > paid OT. Guess that's gone the way of the horse-and-buggy. > > That must be why those surgeons get the big buck. So that they can > hire idiots who take the first thing that's said to them, even though > the patient told you that she had checked multiple times, having been > ensured that coverage is clearly in place. She doesn't ask to speak to > a supervisor, who could have sorted it out before she made my blood > pressure go through the roof. Nope. Just take some office slug's word > for it. Way to do that job. I wonder how many times this woman, who > works exclusively as a liaison between patients and insurance, has > been told something incorrect by the first person who answered the > phone at the insurance call center...Hmmmm. Now THAT has never > happened before! > > I'm trying to take this as calmly as I can. I'm trying to look at it > philosophically, but whenever I do, I come up with pretty much the > same conclusions you came to, which you voiced so eloquently for me. > > Thanks for at least making me smile about this today, Mike. Much, much > appreciated! > > --Cat > > > > > > > --------------------------------- > Everyone is raving about the all-new Yahoo! Mail beta. > > --------------------------------- > Everyone is raving about the all-new Yahoo! Mail beta. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 2, 2006 Report Share Posted December 2, 2006 I work in a doctors office, and though we are not idiots, if I believed everything that came out of my patients mouths I would be in a whole lot of trouble and would be a huge idiot! Could tell you huge stories that would make your hair curl!! Especially when it comes to pain management and medications... Good luck to you in finding out if your insurance is or is not going to cover!! in Maine > > > > baricat wrote: > > Holy freakin' moly, Mike, that was just SOOOO perfect!! I > can tell > > you've got the same sardonic wit that I often get faulted for. > > > > It really does blow me away that I'm left here for the weekend to > stew > > in the bomb dropped by other people's ineptitude. I did all the > > footwork, made it easy, literally BEGGED for a call back before the > > weekend so I wouldn't have to stress for days. Guess that would have > > been a big imposition. That 1-2 minutes she might have had to take > to > > call me and reassure me after the clock struck 4 would have been too > > flippin' much. (That's something I have no patience with. My husband > > works a minimum of 2 hours extra each day, off the clock, because > > that's what it takes to get the job done. When I worked, I'd make > sure > > all loose ends were cleaned up before I left, even though I wasn't > > paid OT. Guess that's gone the way of the horse-and-buggy. > > > > That must be why those surgeons get the big buck. So that they can > > hire idiots who take the first thing that's said to them, even > though > > the patient told you that she had checked multiple times, having > been > > ensured that coverage is clearly in place. She doesn't ask to speak > to > > a supervisor, who could have sorted it out before she made my blood > > pressure go through the roof. Nope. Just take some office slug's > word > > for it. Way to do that job. I wonder how many times this woman, who > > works exclusively as a liaison between patients and insurance, has > > been told something incorrect by the first person who answered the > > phone at the insurance call center...Hmmmm. Now THAT has never > > happened before! > > > > I'm trying to take this as calmly as I can. I'm trying to look at it > > philosophically, but whenever I do, I come up with pretty much the > > same conclusions you came to, which you voiced so eloquently for me. > > > > Thanks for at least making me smile about this today, Mike. Much, > much > > appreciated! > > > > --Cat > > > > > > > > > > > > > > --------------------------------- > > Everyone is raving about the all-new Yahoo! Mail beta. > > > > --------------------------------- > > Everyone is raving about the all-new Yahoo! Mail beta. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 2, 2006 Report Share Posted December 2, 2006 , I hope you know that I didn't mean that EVERY medical office worker is an idiot! However, I'm sure that if this person had a dollar for every error the insurance company reps make, she'd be rich. Now I'm caught between a rock and a hard place. I can't do conference calls. So I have to do my best from here, and hope that when she deigns to call the insurance company again that she'll get someone who can actually read the notes on my file that have it documented. The insurance company won't (or " can't " ) fax anything to me or the doctor's office. HR is no help. Like Mike said, they hand you a pamphlet and you're on your own. It's my husband's insurance, and he works in another state, anyway. I can see why you'd have to be very careful when dispensing Rx for drugs, but this is lifesaving surgery that is, indeed, covered. How tough is it for someone to actually do the work to dig a little?? If I can do it, presumably so can the surgeon's office. --Cat Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 2, 2006 Report Share Posted December 2, 2006 I had a hard time getting specifics from my insurance company as to the exact nature of what they required for approval. I ended up googling it and actually found some of their documents that spelled out the exact terms. I couldn't find it on their website, but Google found it for me. in MI > > Holy freakin' moly, Mike, that was just SOOOO perfect!! I > can tell > > you've got the same sardonic wit that I often get faulted for. > > > > It really does blow me away that I'm left here for the weekend to > stew > > in the bomb dropped by other people's ineptitude. I did all the > > footwork, made it easy, literally BEGGED for a call back before the > > weekend so I wouldn't have to stress for days. Guess that would have > > been a big imposition. That 1-2 minutes she might have had to take > to > > call me and reassure me after the clock struck 4 would have been too > > flippin' much. (That's something I have no patience with. My husband > > works a minimum of 2 hours extra each day, off the clock, because > > that's what it takes to get the job done. When I worked, I'd make > sure > > all loose ends were cleaned up before I left, even though I wasn't > > paid OT. Guess that's gone the way of the horse-and-buggy. > > > > That must be why those surgeons get the big buck. So that they can > > hire idiots who take the first thing that's said to them, even > though > > the patient told you that she had checked multiple times, having > been > > ensured that coverage is clearly in place. She doesn't ask to speak > to > > a supervisor, who could have sorted it out before she made my blood > > pressure go through the roof. Nope. Just take some office slug's > word > > for it. Way to do that job. I wonder how many times this woman, who > > works exclusively as a liaison between patients and insurance, has > > been told something incorrect by the first person who answered the > > phone at the insurance call center...Hmmmm. Now THAT has never > > happened before! > > > > I'm trying to take this as calmly as I can. I'm trying to look at it > > philosophically, but whenever I do, I come up with pretty much the > > same conclusions you came to, which you voiced so eloquently for me. > > > > Thanks for at least making me smile about this today, Mike. Much, > much > > appreciated! > > > > --Cat > > > > > > > > > > > > > > --------------------------------- > > Everyone is raving about the all-new Yahoo! Mail beta. > > > > --------------------------------- > > Everyone is raving about the all-new Yahoo! Mail beta. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 3, 2006 Report Share Posted December 3, 2006 Oh yeah I too do not blame the insurance companies or surgeons in all this. I blame the whole " system " or lack there of. The insurance reps and surgeon/medical reps all have a set list of stuff to run off. They most certainly do have all sorts of asses and whack jobs trying to mess with them, hassle them, make them work outside their scope, etc. ALL DAY EVERY DAY. Still they have some that are just doing their thing to get their justified insurance. Now where the system takes a crap is when you get someone like Cat who can't conference call, might have an unmatching schedule to make calls, insurance/medical folks that can't fax as a matter of policy or time, etc. etc. There may be no blame there other than to nit pick the heck out of the whole thing. There are a lot of very small things Cat has to weed through to get this to work. I guess if I was going to lay blame it might be on the whole sales pitch/premiss that large insurance companies and any medical professional can some how work together better to benefit me simply because some marketer claims the odds are in my favor using them. It's not that that isn't true what the problem is WHEN (not if) you hit the odds and get a non-working situation it's often a HORRIBLE mess of tiny issues instead of one simple fix. Cat, I suggest you find some place, maybe a business like kinko's or a friend's cell phone, where you can do a three way call and try that. Who knows you might be able to even setup a conference time with both an insurance rep and a medical rep. They probably won't want to do the schedule exact but maybe they can give you a best time to try it. I know this might cost some money but you have to big picture this that your long term health is worth this and much more. Mike in GR > > , I hope you know that I didn't mean that EVERY medical office > worker is an idiot! However, I'm sure that if this person had a dollar > for every error the insurance company reps make, she'd be rich. Now > I'm caught between a rock and a hard place. I can't do conference > calls. So I have to do my best from here, and hope that when she > deigns to call the insurance company again that she'll get someone who > can actually read the notes on my file that have it documented. The > insurance company won't (or " can't " ) fax anything to me or the > doctor's office. > > HR is no help. Like Mike said, they hand you a pamphlet and you're on > your own. It's my husband's insurance, and he works in another state, > anyway. > > I can see why you'd have to be very careful when dispensing Rx for > drugs, but this is lifesaving surgery that is, indeed, covered. How > tough is it for someone to actually do the work to dig a little?? If I > can do it, presumably so can the surgeon's office. > > --Cat > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 3, 2006 Report Share Posted December 3, 2006 Mike, that's an excellent suggestion. If, by tomorrow, this isn't sorted out I will see if I can arrange something through Kinkos. I had thought that I should drive to the office, use their phones to get the right person on the line, then hand the phone over to the coordinator. But then, I thought, " Hey, this office is going to be making a young fortune off of me. This is THEIR job to sort out, not mine. Why should I have to do this for her? " If worse comes to worst I will go with another surgeon, as this reflects very, very poorly on how the office is run. Like it or not, it's not just the surgeon I'll have to work with. If they care that little for helping the patient, it's probably not the right place for me to be. --Cat > Cat, > > I suggest you find some place, maybe a business like kinko's or a > friend's cell phone, where you can do a three way call and try that. > Who knows you might be able to even setup a conference time with both > an insurance rep and a medical rep. They probably won't want to do > the schedule exact but maybe they can give you a best time to try it. > I know this might cost some money but you have to big picture this > that your long term health is worth this and much more. > > Mike in GR > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 3, 2006 Report Share Posted December 3, 2006 That's fair enough. You have what could fairly be described by the other parties as " extra needs " . Maybe they don't or can't provide for them. Totally okay all the way around. You just need to find someone who is able to work with those extra needs. I feel for people in rural areas that don't have many choices. I'm not sure but I think even my area only offers maybe three or so options and maybe my insurance only works with the one then. It's rough. Mike > > Mike, that's an excellent suggestion. If, by tomorrow, this isn't > sorted out I will see if I can arrange something through Kinkos. I had > thought that I should drive to the office, use their phones to get the > right person on the line, then hand the phone over to the coordinator. > But then, I thought, " Hey, this office is going to be making a young > fortune off of me. This is THEIR job to sort out, not mine. Why should > I have to do this for her? " > > If worse comes to worst I will go with another surgeon, as this > reflects very, very poorly on how the office is run. Like it or not, > it's not just the surgeon I'll have to work with. If they care that > little for helping the patient, it's probably not the right place for > me to be. > > --Cat > > > > > Cat, > > > > I suggest you find some place, maybe a business like kinko's or a > > friend's cell phone, where you can do a three way call and try that. > > Who knows you might be able to even setup a conference time with both > > an insurance rep and a medical rep. They probably won't want to do > > the schedule exact but maybe they can give you a best time to try it. > > I know this might cost some money but you have to big picture this > > that your long term health is worth this and much more. > > > > Mike in GR > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 3, 2006 Report Share Posted December 3, 2006 Mike, I guess I'm not sure of what " extra needs " you're referring to that " could fairly be described by...other parties. " If by " extra needs " you mean the need to have the surgery covered by the insurance we pay a lot of money for through my husband's employer, well then, yes, I guess I have " extra needs. " Seems to me that I'm just trying to get coverage clarified, the very first step, without which the surgery doesn't happen. What exactly about that denotes " extra needs. " ? Perhaps you mean my " extra needs " to be for the surgeon's insurance liaison to do her job and dig a little (just ask for the next department in the insurance company's pecking order) to get the proper information, then yes, I guess I do have " extra needs. " Funny, I never thought of myself has having " extra needs. " I thought it was perfectly reasonable to expect that in the natural course of things, for people to do the job for which they were hired and for which they are paid, meaning for the insurance liaison in the surgeon's office to spend more than 2 minutes to get the proper insurance information. At this point, I am effectively stalemated until she does do her job. Is that asking so much as to entail " extra needs " ? If it is, please tell me where my reasoning went astray. --Cat > > > > Mike, that's an excellent suggestion. If, by tomorrow, this isn't > > sorted out I will see if I can arrange something through Kinkos. I > had > > thought that I should drive to the office, use their phones to get > the > > right person on the line, then hand the phone over to the > coordinator. > > But then, I thought, " Hey, this office is going to be making a young > > fortune off of me. This is THEIR job to sort out, not mine. Why > should > > I have to do this for her? " > > > > If worse comes to worst I will go with another surgeon, as this > > reflects very, very poorly on how the office is run. Like it or not, > > it's not just the surgeon I'll have to work with. If they care that > > little for helping the patient, it's probably not the right place > for > > me to be. > > > > --Cat > > > > > > > > > Cat, > > > > > > I suggest you find some place, maybe a business like kinko's or a > > > friend's cell phone, where you can do a three way call and try > that. > > > Who knows you might be able to even setup a conference time with > both > > > an insurance rep and a medical rep. They probably won't want to > do > > > the schedule exact but maybe they can give you a best time to try > it. > > > I know this might cost some money but you have to big picture > this > > > that your long term health is worth this and much more. > > > > > > Mike in GR > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 3, 2006 Report Share Posted December 3, 2006 I'm saying they're possibly viewing your need to have them talk to each other instead of using you as a intermdiary, their using a fax repeatedly and/or properly, their using their own phones to conference in all parties for a discussion, stuff like that as " extra needs " that they aren't really authorized on paper to provide. I agree though that if your surgeon's office isn't able to manage the front end at this point then it doesn't bode well for post-op. Mike > > > > > > Mike, that's an excellent suggestion. If, by tomorrow, this isn't > > > sorted out I will see if I can arrange something through Kinkos. I > > had > > > thought that I should drive to the office, use their phones to get > > the > > > right person on the line, then hand the phone over to the > > coordinator. > > > But then, I thought, " Hey, this office is going to be making a young > > > fortune off of me. This is THEIR job to sort out, not mine. Why > > should > > > I have to do this for her? " > > > > > > If worse comes to worst I will go with another surgeon, as this > > > reflects very, very poorly on how the office is run. Like it or not, > > > it's not just the surgeon I'll have to work with. If they care that > > > little for helping the patient, it's probably not the right place > > for > > > me to be. > > > > > > --Cat > > > > > > > > > > > > > Cat, > > > > > > > > I suggest you find some place, maybe a business like kinko's or a > > > > friend's cell phone, where you can do a three way call and try > > that. > > > > Who knows you might be able to even setup a conference time with > > both > > > > an insurance rep and a medical rep. They probably won't want to > > do > > > > the schedule exact but maybe they can give you a best time to try > > it. > > > > I know this might cost some money but you have to big picture > > this > > > > that your long term health is worth this and much more. > > > > > > > > Mike in GR > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 3, 2006 Report Share Posted December 3, 2006 Have you gotten approval from your surgeon for this procedure? baricat wrote: > > Mike, I guess I'm not sure of what " extra needs " you're referring to > that " could fairly be described by...other parties. " If by " extra > needs " you mean the need to have the surgery covered by the insurance > we pay a lot of money for through my husband's employer, well then, > yes, I guess I have " extra needs. " Seems to me that I'm just trying to > get coverage clarified, the very first step, without which the surgery > doesn't happen. What exactly about that denotes " extra needs. " ? > > Perhaps you mean my " extra needs " to be for the surgeon's insurance > liaison to do her job and dig a little (just ask for the next > department in the insurance company's pecking order) to get the proper > information, then yes, I guess I do have " extra needs. " Funny, I never > thought of myself has having " extra needs. " > > I thought it was perfectly reasonable to expect that in the natural > course of things, for people to do the job for which they were hired > and for which they are paid, meaning for the insurance liaison in the > surgeon's office to spend more than 2 minutes to get the proper > insurance information. At this point, I am effectively stalemated > until she does do her job. Is that asking so much as to entail " extra > needs " ? > > If it is, please tell me where my reasoning went astray. > > --Cat > > > > > > > > Mike, that's an excellent suggestion. If, by tomorrow, this isn't > > > sorted out I will see if I can arrange something through Kinkos. I > > had > > > thought that I should drive to the office, use their phones to get > > the > > > right person on the line, then hand the phone over to the > > coordinator. > > > But then, I thought, " Hey, this office is going to be making a young > > > fortune off of me. This is THEIR job to sort out, not mine. Why > > should > > > I have to do this for her? " > > > > > > If worse comes to worst I will go with another surgeon, as this > > > reflects very, very poorly on how the office is run. Like it or not, > > > it's not just the surgeon I'll have to work with. If they care that > > > little for helping the patient, it's probably not the right place > > for > > > me to be. > > > > > > --Cat > > > > > > > > > > > > > Cat, > > > > > > > > I suggest you find some place, maybe a business like kinko's or a > > > > friend's cell phone, where you can do a three way call and try > > that. > > > > Who knows you might be able to even setup a conference time with > > both > > > > an insurance rep and a medical rep. They probably won't want to > > do > > > > the schedule exact but maybe they can give you a best time to try > > it. > > > > I know this might cost some money but you have to big picture > > this > > > > that your long term health is worth this and much more. > > > > > > > > Mike in GR > > > > > > > > > > > > ------------------------------------------------------------------------ > > No virus found in this incoming message. > Checked by AVG Free Edition. > Version: 7.1.409 / Virus Database: 268.15.6/565 - Release Date: 12/2/2006 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 3, 2006 Report Share Posted December 3, 2006 No, Mike. I think either I misstated the situation or you misconstrued it. The surgeon's office can't " use me as an intermediary. " The surgeon's office has to get verification of coverage from the insurance company (United.) I'd be most happy if they'd use their own phones to conference. No objection whatsoever to that. However, there was no solution like that offered by the doctor's office. They just said that the customer service rep at the insurance company said there was an exclusion on my policy (which is incorrect. There is NOT.) End of discussion. She offered no further solutions. She went so far as to say that they would not even submit it, as it would be " kicked back since there's an exclusion. " It's a huge case of an inept, lazy employee giving the wrong answer, which the surgeon's patient/insurance liaison took as gospel. The more I think about her just leaving me up in the air all weekend (I got back to her at the beginning of the afternoon, right after she called me and I got it straightened out with insurance) it does truly not bode well for their patient concern. Too bad, since he's a pretty prestigious surgeon. --Cat wrote: > > I'm saying they're possibly viewing your need to have them talk to > each other instead of using you as a intermdiary, their using a fax > repeatedly and/or properly, their using their own phones to > conference in all parties for a discussion, stuff like that as " extra > needs " that they aren't really authorized on paper to provide. > > I agree though that if your surgeon's office isn't able to manage the > front end at this point then it doesn't bode well for post-op. > > Mike > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 3, 2006 Report Share Posted December 3, 2006 No, , I haven't even gotten so far as seeing the surgeon because they think my insurance won't cover the surgery. However, if you're asking if I'm an appropriate candidate according to my insurance, YES, I am. Although my BMI is under 40, it's over 35, and I have type 2 diabetes, hypertension, venous reflux and about 3 other comorbidities. They don't come better suited. And yes, my PCP has recommended that I do this. But it's all for naught if the surgeon's office won't take the time to connect with the right department at the insurance company, seeing as one of their reps said my policy excludes GB, which it most certainly does not. My policy specifically states a requirement of a BMI of between 35-40 with comorbidities (or 40 without.) --Cat > > Have you gotten approval from your surgeon for this procedure? > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 3, 2006 Report Share Posted December 3, 2006 I am surprised they are contacting your insurance company prior to seeing the surgeon. Just because a PCP recommends it does not necessarily mean a surgeon will approve it. I went through all the steps and my last step was an office visit with my surgeon who approved me for surgery. In the office my surgeon said her office would contact my insurance company and if approved I would hear from her office for a surgery date. She told me the process generally took 1-4 weeks depending on the insurance company. I saw my surgeon on Friday, and on Wednesday afternoon received the call from her office that my insurance approved the surgery. Also, as I work in a medical office, I can tell you we do not call the insurance companies on the telephone for referrals etc...it is all done via fax as we have to fax the doctors notes etc.. I do feel that you are being a little hard on the surgeons office staff, but that is just my humble opinion. I would call back tomorrow morning along with your insurance company. It sounds from what I have read that your insurance company is the one who is causing the chaos... Best wishes and luck to you!! JEnny baricat wrote: > > No, , I haven't even gotten so far as seeing the surgeon because > they think my insurance won't cover the surgery. However, if you're > asking if I'm an appropriate candidate according to my insurance, YES, > I am. Although my BMI is under 40, it's over 35, and I have type 2 > diabetes, hypertension, venous reflux and about 3 other comorbidities. > They don't come better suited. > > And yes, my PCP has recommended that I do this. > > But it's all for naught if the surgeon's office won't take the time to > connect with the right department at the insurance company, seeing as > one of their reps said my policy excludes GB, which it most certainly > does not. My policy specifically states a requirement of a BMI of > between 35-40 with comorbidities (or 40 without.) > > --Cat > > > > > > Have you gotten approval from your surgeon for this procedure? > > > > > > > ------------------------------------------------------------------------ > > No virus found in this incoming message. > Checked by AVG Free Edition. > Version: 7.1.409 / Virus Database: 268.15.6/565 - Release Date: 12/2/2006 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 3, 2006 Report Share Posted December 3, 2006 I'd suspect that different surgeons do things differently. This one won't even see you for a consult without verbal acknowledgement of coverage DIRECTLY from the insurance company. And yes, you're quite right that it's the fault of the insurance company for giving out incorrect information. However, with the information I gave to the surgeon's office so that they could find out the correct information, I would hope they'd follow up and do it. I can't do it for them - if I could, I would. After you meet with the surgeon then they send in the written clinical review for predetermination. Only at that point do they contact you in order to schedule a date. So I'm not even out of the gate yet. Because of the ineptitude of the insurance company rep and because of the unwillingness of the surgeon's office to pursue it beyond a 1 minute phone call to a call center rep, I'm stymied. Understood that the surgeon hasn't approved me. However, it's hard to imagine why he wouldn't. Supposedly I'm an excellent candidate in good health with an established exercise routine with many requisite comorbidities (only one is required at my BMI.) But I can't do anymore. That's why I'm beginning to think that I'm going to have to go to another surgeon. I have an appointment to see one on 12/13. Maybe he and his office will not be so quick to accept erroneous information without investigating its accuracy. I can only hope that they will listen to me. As a medical office worker, it would seem I've offended you. I do not mean you, and I never meant you. I'm sure you're superb at your job, and never meant any disrespect. The fact remains that the surgeon's insurance/patient liaison has not done her job and it's very frustrating. It's not worth another phone call to her. I have tried to get the insurance company to fax something to her, but they say they can't do that. I've tried to advocate for myself, but what more would you suggest I do? If I could do the insurance/patient liaison's job for her, at this point I'd do it gladly. Too bad for the surgeon and too bad for me. The only one who isn't suffering from this is the surgeon's employee, so I wouldn't feel so bad for her. --Cat > > > > > > Have you gotten approval from your surgeon for this procedure? > > > > > > > > > > > > ------------------------------------------------------------------------ > > > > No virus found in this incoming message. > > Checked by AVG Free Edition. > > Version: 7.1.409 / Virus Database: 268.15.6/565 - Release Date: 12/2/2006 > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 4, 2006 Report Share Posted December 4, 2006 Cat, another suggestion as to why you are getting two differant answers. When I started, I called and was told RNY was covered, then my dr called and said it wasn't. After calling the Insurance, I found out that the particular company covered regular RNY, but not Laproscopic, and Lap is what my surgeon prefferred, so, being Medicaid, and with incredible luck that it happened to be Open enrollment, I was able to change my insurance to the one that covered LAP. so, it may be that the particular way of doing the surg is not covered, but another way might be. Just an idea that might help. Donna in VA LAP RNY 9-18-06 315/255/171 Re: I Need To Vent!! Mike, that's an excellent suggestion. If, by tomorrow, this isn't sorted out I will see if I can arrange something through Kinkos. I had thought that I should drive to the office, use their phones to get the right person on the line, then hand the phone over to the coordinator. But then, I thought, " Hey, this office is going to be making a young fortune off of me. This is THEIR job to sort out, not mine. Why should I have to do this for her? " If worse comes to worst I will go with another surgeon, as this reflects very, very poorly on how the office is run. Like it or not, it's not just the surgeon I'll have to work with. If they care that little for helping the patient, it's probably not the right place for me to be. --Cat > Cat, > > I suggest you find some place, maybe a business like kinko's or a > friend's cell phone, where you can do a three way call and try that. > Who knows you might be able to even setup a conference time with both > an insurance rep and a medical rep. They probably won't want to do > the schedule exact but maybe they can give you a best time to try it. > I know this might cost some money but you have to big picture this > that your long term health is worth this and much more. > > Mike in GR > We are a very active support group. If the email becomes overwhelming, please change your setting to NO EMAIL! Please contact Group Creator Robyn@... Quote Link to comment Share on other sites More sharing options...
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