Guest guest Posted October 31, 2001 Report Share Posted October 31, 2001 I can hardly believe it -- I'm actually approved for the DS with Dr. Keshishian!! It's an amazing story of how it all happened, and it'd give me some sort of repetitive stress injury if I tried to type it all out in detail, but here's the gist... Oct 16: Dr. K faxes LOMN to Cigna (PPO) Oct 18: I call Cigna -- no record of fax, so Dr. K faxes again. Oct 19: I call Cigna -- no record of fax, so Dr. K faxes a THIRD time. Oct 22: fax finally registered...all Cigna will tell me is that it's gone to medical review, and I'll know something " within 30 days. " Oct 28: I talked to Deanna Truely (who " truly " is an angel!), who told me to be more persistent, and I remembered the *one* customer service rep at Cigna who had *ever* been really supportive. Oct 29: I called my Cigna angel, who apologized for the run around I'd been getting and told me she'd get a copy of the fax and would take it to med review herself and get me an answer that day or the next. She called me back within an hour -- she couldn't even get a copy of the fax -- it'd been sent to be microfilmed or somesuch thing, and she was told to wait a week. She asked me to ask Dr. K to fax a *4th* time (poor Olga!!) to her attention, and she gave me her fax number. I called Olga and gave her my Cigna angel's phone and fax numbers, and Olga called Cigna for me...faxed the document...and within an hour I was APPROVED!! Un-flippin'-believable! I still can hardly believe it. I have a hardcopy of the approval in my hot little hands, and even though I've read it a million times, I am still so stunned by those words " you're approved. " So THANK YOU, Deanna, for encouraging me to be a pest, and THANK YOU Amy S. for your constant optomism wrt Cigna and for getting approved by Cigna PPO so quickly and giving me hope that it could happen that quickly for me, and THANK YOU Dr. K's office for being so patient with the millions of faxes, and THANK YOU to the people on Dr. R's list and Dr. K's list, and the main DS list for giving me confidence, information, support, and most importantly HOPE that I might someday see the other side. I could go on and on (those who know me in person KNOW I can go on and on!! , but there's the gist of it: I will be SWITCHED on December 20, and Cigna's even going to pay for it!!!!! ) With much love for all, alyssa Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 31, 2001 Report Share Posted October 31, 2001 Congratulations Alyssa....You are on your way to a new life!!!!!!!!!!!!!!!! *hugs* Lisbeth alyssaj@... wrote: I can hardly believe it -- I'm actually approved for the DS with Dr. Keshishian!! It's an amazing story of how it all happened, and it'd give me some sort of repetitive stress injury if I tried to type it all out in detail, but here's the gist... Oct 16: Dr. K faxes LOMN to Cigna (PPO) Oct 18: I call Cigna -- no record of fax, so Dr. K faxes again. Oct 19: I call Cigna -- no record of fax, so Dr. K faxes a THIRD time. Oct 22: fax finally registered...all Cigna will tell me is that it's gone to medical review, and I'll know something " within 30 days. " Oct 28: I talked to Deanna Truely (who " truly " is an angel!), who told me to be more persistent, and I remembered the *one* customer service rep at Cigna who had *ever* been really supportive. Oct 29: I called my Cigna angel, who apologized for the run around I'd been getting and told me she'd get a copy of the fax and would take it to med review herself and get me an answer that day or the next. She called me back within an hour -- she couldn't even get a copy of the fax -- it'd been sent to be microfilmed or somesuch thing, and she was told to wait a week. She asked me to ask Dr. K to fax a *4th* time (poor Olga!!) to her attention, and she gave me her fax number. I called Olga and gave her my Cigna angel's phone and fax numbers, and Olga called Cigna for me...faxed the document...and within an hour I was APPROVED!! Un-flippin'-believable! I still can hardly believe it. I have a hardcopy of the approval in my hot little hands, and even though I've read it a million times, I am still so stunned by those words " you're approved. " So THANK YOU, Deanna, for encouraging me to be a pest, and THANK YOU Amy S. for your constant optomism wrt Cigna and for getting approved by Cigna PPO so quickly and giving me hope that it could happen that quickly for me, and THANK YOU Dr. K's office for being so patient with the millions of faxes, and THANK YOU to the people on Dr. R's list and Dr. K's list, and the main DS list for giving me confidence, information, support, and most importantly HOPE that I might someday see the other side. I could go on and on (those who know me in person KNOW I can go on and on!! , but there's the gist of it: I will be SWITCHED on December 20, and Cigna's even going to pay for it!!!!! ) With much love for all, alyssa ---------------------------------------------------------------------- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 1, 2001 Report Share Posted November 1, 2001 According to a telphone conversation with customer service at my insurance company today, I am approved!! Dr. Hess requested the following numbers 43877, 43633, 44130 and 47600. I was approved for 43877 and 43633. The insurance company called it gastric bypass. Said I was approved for that but not the other two " incidental " things. I called Dr. Hess' office and told them. They said that is the way Medical Mutual always does it. The 47600 is gall bladder removal and Medical Mutual won't approve that until they get the pathology report (after it is taken out). I don't know what the other number is for - maybe appendix? Anyway, Dr. Hess' office was not concerned in the least that it was approved this way. In fact, if I had wanted to, I could have had a date in November or December and I would have taken one of those had I had the $2500 upfront money, which I haven't had enough time to save yet. So - as of this writing, I am still scheduled for Jan. 22, 2001 and hopefully I will have the upfront $$ by then and be very prepared. Just wanted to let you all know I am approved!! PS Whatever numbers Dr. Hess uses, he has done this many years and gotten approvals from my company for others, so I don't really care. I know I am getting the BPD/DS (thats all he does) and that he knows what they will approve. They call it the Gastric Bypass Long Limb Reu En Y or something like that. Carole Broderick Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 1, 2001 Report Share Posted November 1, 2001 Hi. Don't you mean 43847 for the main part of the surgery and 43633 secondarily? You have now, in effect, answered some questions I was having. That is, for the high-priced surgeons, why not just bill more of these other codes to get more money from the insurance company instead of from us poor slobs who pay the premiums? (It is good to know that these doctors ARE trying to do this!) Answer is, surgeons can only bill for one code primarily (43847 gives them the most money) and then maybe one (two?) more secondarily which is usually paid at 50% of the allowable charge (43633 gives them the next big bang for the buck). Oh yeah--I'm not positive about the CPT billing procedures (although the codes are correct) but this is what I've been able to understand is happening based on my own research and talking to certified coders. Not sure if I'm exactly correct. I guess that when the surgeon is in there anyway, there's no reason to charge for removing something like an appendix, which could be the equivalent of us putting a glass in the dishwasher as we clean up after the main Thanksgiving kitchen mess. Yes, I'm already thinking turkey and how I won't be able to eat my Mama's AGAIN this year (last year--remodeling the house)unless my insurance company moves their butts in time for me to get an earlier surgery date than November 20. Oh well. FYI: 43847=gastric restrictive procedure (same for distal RNY) 43633=gastrectomy, partial, w/gastroduodenostomy 44130=enterostomy, anastomosis of intestine (often considered an integral part of 43633) 47600=gall bladder (cholecystectomy) 44960=appendectomy > According to a telphone conversation with customer service at my insurance company today, I am approved!! > Dr. Hess requested the following numbers 43877, 43633, 44130 and 47600. I was approved for 43877 and 43633. The insurance company called it gastric bypass. Said I was approved for that but not the other two " incidental " things. I called Dr. Hess' office and told them. They said that is the way Medical Mutual always does it. The 47600 is gall bladder removal and Medical Mutual won't approve that until they get the pathology report (after it is taken out). I don't know what the other number is for - maybe appendix? Anyway, > Dr. Hess' office was not concerned in the least that it was approved this way. > In fact, if I had wanted to, I could have had a date in November or December and I would have taken one of those had I had the $2500 upfront money, which I haven't had enough time to save yet. So - as of this writing, I am still scheduled for Jan. 22, 2001 and hopefully I will have the upfront $$ by then and be very prepared. > Just wanted to let you all know I am approved!! > PS Whatever numbers Dr. Hess uses, he has done this many years and gotten approvals from my company for others, so I don't really care. I know I am getting the BPD/DS (thats all he does) and that he knows what they will approve. They call it the Gastric Bypass Long Limb Reu En Y or something like that. > Carole Broderick Quote Link to comment Share on other sites More sharing options...
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