Guest guest Posted June 30, 2000 Report Share Posted June 30, 2000 As grandma used to say I'm so angry I could spit. I think we ought to be able to sue insurance companies for mental suffering for the deliberate abuse they give us. On Monday I called CIGNA, my insurance provider, explained that I wanted mgb, gave them my weight, height and comorbidities. The customer service representative (whose full name I got) told me that gastric bypass surgery IS covered for morbid obesity. She also gave me the company fax # that Dr R should fax his letter to. I submitted my online form on Monday of this week. Of course I gave Dr R the CIGNA fax # that the representative gave me. On Tuesday I called Dr R's office and spoke with Debbie about what the process would be from there on out. She suggested that the insurance company would probably refuse to even consider the letter without at least a " referral for consultation " from my PCP. At the moment I can't get a full referral due to severe anemia but there should be no problem getting a referral for consultation. I immediately faxed a letter to my PCP asking for the referral for consultation. In today's, Friday's, mail I received a copy from Dr R of the letter he sent CIGNA on the same day I sent my online form (Monday). I immediately called CIGNA to see what their determination was of Dr R's request. They had the nerve to tell me they hadn't received the letter. The customer service representative acted a little surprised when I pulled out my notebook and repeated to her the name, time, date and detailed conversation that I had with the csr on Monday and the incorrect fax number she gave me. The csr gave me her fax # plus she gave me the Benefits Review Department's fax #. I immediately faxed Dr R's letter to both numbers and asked them to confirm by email that they had received it. Needless to say 2 hours later I still hadn't received confirmation from them that they had received it. So I called again and talked to and 3rd csr. At first she tried to tell me that they had not received any of the 3 faxes sent to the 3 different fax numbers they had given me. When I gave her everyone's names, dates, and a rundown on our conversation she put me on hold to " look into the matter. " Guess what. Miracle of miracles they found the faxes BUT...... Now (just like Debbie warned me) they won't consider Dr R's letter until my PCP issues a referral for consultation. SO - I called my PCP's office and spoke to his clerical person. She said that the doctor had given his approval for the referral and it was currently on her desk for her to complete the paperwork for the approval. I asked her what the referral # was and she said that she was leaving in 30 minutes and probably wouldn't be able to work on it until Wednesday, July 5. SO - bright and early July 6 I will be calling my PCP's office to insure they properly completed the paperwork and then I'll start hounding the insurance company again. These people don't realize that I HAVE MADE UP MY MIND AND DAMN IF THEY AREN'T GOING TO APPROVE THIS ONE WAY OR THE OTHER. I hope all this helps someone understand the pitfalls, excuses and obstacles that are presented to us. I hope you learn from my experience. Bottom line - Dr R and his office seem to really have it together - everyone else could care less JC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2000 Report Share Posted June 30, 2000 JC, I got so excited reading your post about the runaround I had " da goose bumps. " KICK ASS AND TAKE NAMES!!! Thats what I like to hear WOMAN. You got savvy and savagery. Those out there who are a little reticent about all the rock and roll you might get from your insurance companies, make a copy of JCs runaround post and refer to it for inspiration. Dena Lawton appraiseca@... wrote: > As grandma used to say I'm so angry I could spit. > > I think we ought to be able to sue insurance companies for mental suffering > for the deliberate abuse they give us. > > On Monday I called CIGNA, my insurance provider, explained that I wanted mgb, > gave them my weight, height and comorbidities. The customer service > representative (whose full name I got) told me that gastric bypass surgery IS > covered for morbid obesity. She also gave me the company fax # that Dr R > should fax his letter to. > > I submitted my online form on Monday of this week. Of course I gave Dr R the > CIGNA fax # that the representative gave me. > > On Tuesday I called Dr R's office and spoke with Debbie about what the > process would be from there on out. > > She suggested that the insurance company would probably refuse to even > consider the letter without at least a " referral for consultation " from my > PCP. At the moment I can't get a full referral due to severe anemia but > there should be no problem getting a referral for consultation. > > I immediately faxed a letter to my PCP asking for the referral for > consultation. > > In today's, Friday's, mail I received a copy from Dr R of the letter he sent > CIGNA on the same day I sent my online form (Monday). > > I immediately called CIGNA to see what their determination was of Dr R's > request. They had the nerve to tell me they hadn't received the letter. The > customer service representative acted a little surprised when I pulled out my > notebook and repeated to her the name, time, date and detailed conversation > that I had with the csr on Monday and the incorrect fax number she gave me. > > The csr gave me her fax # plus she gave me the Benefits Review Department's > fax #. I immediately faxed Dr R's letter to both numbers and asked them to > confirm by email that they had received it. > > Needless to say 2 hours later I still hadn't received confirmation from them > that they had received it. So I called again and talked to and 3rd csr. At > first she tried to tell me that they had not received any of the 3 faxes sent > to the 3 different fax numbers they had given me. When I gave her everyone's > names, dates, and a rundown on our conversation she put me on hold to " look > into the matter. " > > Guess what. Miracle of miracles they found the faxes BUT...... > > Now (just like Debbie warned me) they won't consider Dr R's letter until my > PCP issues a referral for consultation. > > SO - I called my PCP's office and spoke to his clerical person. She said > that the doctor had given his approval for the referral and it was currently > on her desk for her to complete the paperwork for the approval. I asked her > what the referral # was and she said that she was leaving in 30 minutes and > probably wouldn't be able to work on it until Wednesday, July 5. > > SO - bright and early July 6 I will be calling my PCP's office to insure they > properly completed the paperwork and then I'll start hounding the insurance > company again. > > These people don't realize that I HAVE MADE UP MY MIND AND DAMN IF THEY > AREN'T GOING TO APPROVE THIS ONE WAY OR THE OTHER. > > I hope all this helps someone understand the pitfalls, excuses and obstacles > that are presented to us. I hope you learn from my experience. > > Bottom line - Dr R and his office seem to really have it together - everyone > else could care less > > JC > > ------------------------------------------------------------------------ > 0% Introductory APR! > Instant Approval! > Aria Visa - get yours today. > http://click.egroups.com/1/6035/3/_/453517/_/962393537/ > ------------------------------------------------------------------------ > > This message is from the Mini-Gastric Bypass Mailing List at Onelist.com > Please visit our web site at http://clos.net > Get the Patient Manual at http://clos.net/get_patient_manual.htm Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2000 Report Share Posted June 30, 2000 JC You Go Girl. in Durham and moving to Chapel Hill soon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2000 Report Share Posted June 30, 2000 JC You Go Girl. in Durham and moving to Chapel Hill soon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2000 Report Share Posted June 30, 2000 JC You Go Girl. in Durham and moving to Chapel Hill soon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 30, 2000 Report Share Posted June 30, 2000 Whew!! I wouldn't want to mess with you. I also hounded my insurance company and agree with you. I had a binder for my manual, a binder for my info to be sent to Dr. R and a notebook of insurance info. Always get names and write notes. I bet they will know you the next time you call. Good Luck, now is the luck for them or you? Darlene appraiseca@... wrote: > As grandma used to say I'm so angry I could spit. > > I think we ought to be able to sue insurance companies for mental suffering > for the deliberate abuse they give us. > > On Monday I called CIGNA, my insurance provider, explained that I wanted mgb, > gave them my weight, height and comorbidities. The customer service > representative (whose full name I got) told me that gastric bypass surgery IS > covered for morbid obesity. She also gave me the company fax # that Dr R > should fax his letter to. > > I submitted my online form on Monday of this week. Of course I gave Dr R the > CIGNA fax # that the representative gave me. > > On Tuesday I called Dr R's office and spoke with Debbie about what the > process would be from there on out. > > She suggested that the insurance company would probably refuse to even > consider the letter without at least a " referral for consultation " from my > PCP. At the moment I can't get a full referral due to severe anemia but > there should be no problem getting a referral for consultation. > > I immediately faxed a letter to my PCP asking for the referral for > consultation. > > In today's, Friday's, mail I received a copy from Dr R of the letter he sent > CIGNA on the same day I sent my online form (Monday). > > I immediately called CIGNA to see what their determination was of Dr R's > request. They had the nerve to tell me they hadn't received the letter. The > customer service representative acted a little surprised when I pulled out my > notebook and repeated to her the name, time, date and detailed conversation > that I had with the csr on Monday and the incorrect fax number she gave me. > > The csr gave me her fax # plus she gave me the Benefits Review Department's > fax #. I immediately faxed Dr R's letter to both numbers and asked them to > confirm by email that they had received it. > > Needless to say 2 hours later I still hadn't received confirmation from them > that they had received it. So I called again and talked to and 3rd csr. At > first she tried to tell me that they had not received any of the 3 faxes sent > to the 3 different fax numbers they had given me. When I gave her everyone's > names, dates, and a rundown on our conversation she put me on hold to " look > into the matter. " > > Guess what. Miracle of miracles they found the faxes BUT...... > > Now (just like Debbie warned me) they won't consider Dr R's letter until my > PCP issues a referral for consultation. > > SO - I called my PCP's office and spoke to his clerical person. She said > that the doctor had given his approval for the referral and it was currently > on her desk for her to complete the paperwork for the approval. I asked her > what the referral # was and she said that she was leaving in 30 minutes and > probably wouldn't be able to work on it until Wednesday, July 5. > > SO - bright and early July 6 I will be calling my PCP's office to insure they > properly completed the paperwork and then I'll start hounding the insurance > company again. > > These people don't realize that I HAVE MADE UP MY MIND AND DAMN IF THEY > AREN'T GOING TO APPROVE THIS ONE WAY OR THE OTHER. > > I hope all this helps someone understand the pitfalls, excuses and obstacles > that are presented to us. I hope you learn from my experience. > > Bottom line - Dr R and his office seem to really have it together - everyone > else could care less > > JC > > ------------------------------------------------------------------------ > 0% Introductory APR! > Instant Approval! > Aria Visa - get yours today. > http://click.egroups.com/1/6035/3/_/453517/_/962393537/ > ------------------------------------------------------------------------ > > This message is from the Mini-Gastric Bypass Mailing List at Onelist.com > Please visit our web site at http://clos.net > Get the Patient Manual at http://clos.net/get_patient_manual.htm Quote Link to comment Share on other sites More sharing options...
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