You've got to keep on top of them!!

[Guest guest]

I called Debbie to ask about precertification, and she said that Barbara will

do that.. She said that is the ONLY time they call the insurance companies,

so you shouldn't have to worry about it. Was this true for everyone else?

Deb in IL

[Guest guest]

Insurance companies, I mean!

I called mine last week to confirm they had received my PCP's and Dr.

R's letters. They had my PCP's, not Dr. R.'s, so I had Debbie fax it to

them. I then confirmed they had the faxed letter and asked how long it

would take to get the approval. I was told 1 week.

So I call today, and the gal tells me it has been sent to the pre-cert

department and that they will take a fine-tooth comb to go over it, and

it would take quite some time. She even checked with another gal to

make sure it was in the new department.

I get off the phone and started catching up on emails from the list, and

then thought, " you know, I should probably check with that other

department to make sure they have received the request " . So I called

and talked to the new department and am informed that they don't have

anything! She checked my other family member's files, thinking it could

have been misplaced. Still nothing. So then she gets the first

department in a conference call with me and we determine that the info

needs to be sent again to the pre-cert department. I told them I would

call again tomorrow and/or the next day to make sure the info gets where

it needs to be.

So...why am I telling you this?? Because I want to remind anyone else

out there who is fighting for approval right now that you need to call,

and make sure they aren't misplacing your info, or assuming someone else

is taking care of it. You have got to stay on top of them!!

Tricia in IL

whose emotions are ever-changing right now as I wait to hear my fate!!

[Guest guest]

> Insurance companies--you have got to stay on top of them!!

Tricia--

What a " koinkydink " ! I have been going through the exact same thing

since last Friday. Debbie at Dr. R's office has been kind enough to

send my fax three different times (to two different phone numbers) and

the insurance company STILL can't seem to find any of them!

I have been transferred all over the country (literally from land

to California to Kansas to Colorado and back to land) in an

attempt to locate Dr. R's letter!

In fact, as I type this, I've been on hold for at least 10 minutes

now

trying to find a supervisor at the insurance company to speak with!

It's soooooo frustrating!

Hangin' in there with you---

Dawn Jester

Wichita, KS

[Guest guest]

Keep on them, Dawn! We WILL prevail!!!!!!!!!!!!

Tricia = )

Dawn Jester wrote:

>

>

> > Insurance companies--you have got to stay on top of them!!

>

> Tricia--

>

> What a " koinkydink " ! I have been going through the exact same thing

> since last Friday. Debbie at Dr. R's office has been kind enough to

> send my fax three different times (to two different phone numbers) and

> the insurance company STILL can't seem to find any of them!

>

> I have been transferred all over the country (literally from land

> to California to Kansas to Colorado and back to land) in an

> attempt to locate Dr. R's letter!

>

> In fact, as I type this, I've been on hold for at least 10 minutes

> now

> trying to find a supervisor at the insurance company to speak with!

>

> It's soooooo frustrating!

>

> Hangin' in there with you---

>

> Dawn Jester

> Wichita, KS

>

> ----------------------------------------------------------------------

>

> ----------------------------------------------------------------------

> 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

>

> To Unsubscribe Send and Email to:

> MiniGastricBypass-unsubscribe (AT) egroups (DOT) com

[Guest guest]

Vaughn and Sara Schütz wrote:

> We had to give them a

> " dummy " surgery date before they would consider pre-certifying me.

Well, hey, that brings up an interesting question.....

When I was talking to one of the many insurance reps today, I asked

about pre-cert vs pre-authorization. I should be pursuing

pre-certification, and to do that, I need a surgery date! So, can I

give them a surgery date, or should Dr. R do that??

Tricia in IL

[Guest guest]

I meant can I give them a " dummy " date or should Dr. R do that?

Tricia Bardell wrote:

>

> Vaughn and Sara Schütz wrote:

> > We had to give them a

> > " dummy " surgery date before they would consider pre-certifying me.

>

> Well, hey, that brings up an interesting question.....

> When I was talking to one of the many insurance reps today, I asked

> about pre-cert vs pre-authorization. I should be pursuing

> pre-certification, and to do that, I need a surgery date! So, can I

> give them a surgery date, or should Dr. R do that??

>

> Tricia in IL

> ----------------------------------------------------------------------

>

> ----------------------------------------------------------------------

> 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

>

> To Unsubscribe Send and Email to:

> MiniGastricBypass-unsubscribe (AT) egroups (DOT) com

[Guest guest]

Hi Tricia,

Good luck with your insurance! You're right, you have to keep calling and

calling and never take anything for granted. Dr. R's letter was mailed to my

insurance company and then faxed twice before they finally admitted to getting

it. We had a real run around until we finally found out who our case had been

assigned to. And even that was hard to do, because they said it had been

assigned to one person, but when we talked to her, she had nothing, and it

turned out it had not been assigned to her after all. When we finally got to

the right person, she was very helpful, but it was very discouraging because

they were requiring a lot more information (diet histories, nutrition consults,

medical records, psych evaluation, etc.). Well, we finally got everything that

we could together and sent it all in. They got the last piece of information

they needed on Friday afternoon. On Monday morning we got a call that I was

approved!!!!

Now I know from what the person assigned to our case said that there was no

deliberation about whether to approve this at all until all the info they

wanted was in. It had to all be there before it was sent to anyone (in our

case it was a doctor) for review. So that means that the doctor reviewed all

that info and approved the surgery in a very short amount of time. It is

ridiculous, I think, for them to need many days or weeks to make a decision. I

think that is another stalling tactic. Maybe if you tell them that you need to

have the surgery very soon, then they will hurry. We had to give them a

" dummy " surgery date before they would consider pre-certifying me.

Anyway, I wish you and all the others waiting for insurance approval the best!

My thoughts and prayers are with you.

Sara

MGB 8/2

Tricia Bardell wrote:

> Insurance companies, I mean!

>

> I called mine last week to confirm they had received my PCP's and Dr.

> R's letters. They had my PCP's, not Dr. R.'s, so I had Debbie fax it to

> them. I then confirmed they had the faxed letter and asked how long it

> would take to get the approval. I was told 1 week.

>

> So I call today, and the gal tells me it has been sent to the pre-cert

> department and that they will take a fine-tooth comb to go over it, and

> it would take quite some time. She even checked with another gal to

> make sure it was in the new department.

>

> I get off the phone and started catching up on emails from the list, and

> then thought, " you know, I should probably check with that other

> department to make sure they have received the request " . So I called

> and talked to the new department and am informed that they don't have

> anything! She checked my other family member's files, thinking it could

> have been misplaced. Still nothing. So then she gets the first

> department in a conference call with me and we determine that the info

> needs to be sent again to the pre-cert department. I told them I would

> call again tomorrow and/or the next day to make sure the info gets where

> it needs to be.

>

> So...why am I telling you this?? Because I want to remind anyone else

> out there who is fighting for approval right now that you need to call,

> and make sure they aren't misplacing your info, or assuming someone else

> is taking care of it. You have got to stay on top of them!!

>

> Tricia in IL

> whose emotions are ever-changing right now as I wait to hear my fate!!

>

[Guest guest]

> Keep on them, Dawn! We WILL prevail!!!!!!!!!!!!

Tricia--

I had a brainstorm after I left the last message for you. I called

our corporate controller at our corporate office in land (because

I have company insurance and he's responsible for employee benefits)

and asked for his assistance. He was nice enough to

immediately conference a call with our official insurance

representative at the insurance company who said he'd get involved

and possibly even get an answer today! I assured him that I didn't

necessarily need people to be jumping through hoops and that an

answer by the end of the week would be fantastic! He said either

way, he'd get back to me with a status later today!

Not bad, huh? Now we'll see if it works! Maybe you could try

something like it?

Good luck!

Dawn Jester

Wichita, Kansas

[Guest guest]

Tricia Bardell wrote:

>

> Insurance companies, I mean!

<snip>

> So...why am I telling you this?? Because I want to remind anyone else

> out there who is fighting for approval right now that you need to

> call,

> and make sure they aren't misplacing your info, or assuming someone

> else

> is taking care of it. You have got to stay on top of them!!

>

> Tricia in IL

> whose emotions are ever-changing right now as I wait to hear my fate!!

You go, girl!!

Kind regards,

[Guest guest]

> I meant can I give them a " dummy " date or should Dr. R do that?

Tricia--

When I talked to my insurance company, the rep said they also needed

a date. I told him that I didn't have a date yet. He said " fine,

then why don't we just fill in August 1. If it changes once you get

an official date, it's no problem to change it. " He also said that

putting in an earlier date than what I thought would be the official

date would probably help expedite the approval (or denial, sigh).

So it seems that giving a " dummy " date is not a big deal.

Hope this helps!

Dawn Jester

Wichita, Kansas

[Guest guest]

Hi Tricia,

The person handling our case at the insurance company said it would move things

along more quickly to have a surgery date, and that I could just give her a

" dummy date " (her words). So we just said OK how about July 14th? So they

just put that down on our say-so, they didn't need anything from Dr. R's

office. Once things were approved, it was past July 14th, but the case worker

just called Dr. R's office to set up a real date. I called before she did and

told Debbie I wanted Aug. 2nd, and she said that's what she would tell the

insurance person when she called. I'm not sure if all insurance companies work

the same way, but maybe you could try the " dummy date " approach.

Sara

Tricia Bardell wrote:

> Vaughn and Sara Schütz wrote:

> > We had to give them a

> > " dummy " surgery date before they would consider pre-certifying me.

>

> Well, hey, that brings up an interesting question.....

> When I was talking to one of the many insurance reps today, I asked

> about pre-cert vs pre-authorization. I should be pursuing

> pre-certification, and to do that, I need a surgery date! So, can I

> give them a surgery date, or should Dr. R do that??

>

> Tricia in IL

>

> ------------------------------------------------------------------------

> Best friends, most artistic, class clown Find 'em here:

> http://click.egroups.com/1/7078/3/_/453517/_/964036278/

> ------------------------------------------------------------------------

>

> 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

>

> To Unsubscribe Send and Email to: MiniGastricBypass-unsubscribe (AT) egroups (DOT) com

[Guest guest]

Yes, Barbara told me that they don't call the insurance companies during the

approval process. I think they would be absolutely swamped if they had to get

involved on the phone with these insurance companies a lot during all the

preliminary stuff.

Sara

Hadjab@... wrote:

> I called Debbie to ask about precertification, and she said that Barbara will

> do that.. She said that is the ONLY time they call the insurance companies,

> so you shouldn't have to worry about it. Was this true for everyone else?

>

> Deb in IL

>

>