dont take NO for an answer....

I feel like the weight of the world has been lifted off my shoulders! I have been approved for surgery!

I started my journey at Lahey Clinic in Burlington Ma while under United Health Care coverage, everything was going along fine they paid for everything. On 01.01.10 I got married and went on my husband’s RI Blue Cross ChiP plan that’s when all the problems began. I kept going to Lahey, following the program giving them my new blue cross card as they were submitting bills Blue Cross is not paying, no one is notifying me! I’m not getting rejection notices from Blue Cross and I’m not getting bills from Lahey.

I’m given a surgery date of April 9th…I get a call from Lahey Blue Cross denied your surgery. I call Blue Cross the 1st person tells me I need to have a PCP in the state of RI not in MA. But my PCP and all my other Dr’s are at Lahey in MA. So I call a personal friend who is a DR here in RI make an appt with her she recommends I have the surgery at Lahey in MA, submits the paperwork to Blue Cross Denied AGAIN. WHY because the surgery can be preformed her e in RI! It seems that my husbands Blue Cross will only cover out of state claims of you have an emergency out of state or you can not find the service you need locally. I have been at Lahey Clinic since 1976 and now I can’t go! L

So my Dr friend recommends a new Dr here in the local area, from my research on the internet he gets high marks his staff not so much. It took over six weeks to get an appt with the Dr because his assistant would not listen to me that I had been thru a program and was scheduled for surgery and this was just a Blue Cross mess up. She refused to schedule an appointment until my 33 page lapband medical history was reviewed. I did finally see the doc and I don’t have to go thru his program since I have done all the preop work at Lahey. When he told the assistant that I did not need to go thru their program she gave him push back right in front of me!!!

I just found out yesterday that Blue Cross approved my surgery I need to have a few more tests (upper gi, chest x-ray and blood work) and then I can get a date.

Moral of the story don’t give up when your insurance provider says no.

BTW we are switching to United Health care in January 2011, and I’m going back to Lahey for my fills and everything else.