SCREAMING in FRUSTRATION

[Mvpo8961 1]

Well my insurance company sent a LETTER to my surgeon requesting the facility that would be used for my banding. So I guess this will now be the third attempt to present the letter of Pred? But in this day of advanced technology they sent it by POSTAL SERVICE instead of a FAX or EMAIL. They WILL NOT take the information from me only from my surgeon. I have HCA UHC!!!!!!!!! MY husband works for the HOSPITAL. It is part of our insurance contract that to be covered by insurance it has to be done at an HCA facility. The surgeon's office is IN THE HCA facility for crying out loud. Why would I submit for insurance coverage and then go ANYPLACE ELSE where it wouldn't be covered by insurance.

I can do this. Just take a deep breath. Patience is a virtue. Patience is a virtue. Patience is a virtue. M:pout:

[shackdog 1]

hang in there it can be very frustrating

[banded_for_life 2]

Deep calming breath....breath in...breath out...breath in and breath out...now doesn't that feel better! (ducks as oncoming shoe missle) I know how frustrating the waiting can be...just hang in there!

[Mvpo8961 1]

Smacking myself. Whack - Whack-Whack. It could always be worse. I could not have insurance or have to do a twelve month weight loss program first. M:frusty:

[Shelby 0]

Hang in there -- I know it's frustrating as heck but you will get thru this.

[3loves 0]

Hi Mvpo ~ I know we've both been waiting , but to find out they didn't have your PreD?? Sounds like someone at UHC didn't have their morning coffee. Did your surgeon's office tell you the method of sending the info? I would try to find out and follow the trail with the new info to make sure it arrives safely. I have been documenting EVERY conversation with date, time, & person spoken to from the very beginning. Even if I have to leave a message, I would put LMOR (left message on recorder) with date & time. I have notes from Jan.

The hardest part, the waiting, is almost over. Hang in there....it's getting closer....I can FEEL it!! :dance:

I have one more support group to attend and I'm going to have to wait until the first week of April for a meeting. :cry Oh well, at least they haven't told me no.

[Mvpo8961 1]

:update: Just talked to the ins co and they haven't received the requeste additional info from surgeon's office yet. Remember all they need is the NAME OF THE FACILITY to be used. They won't let me tell them verbally they must receive in writing from surgeon. OKAY. So today the rep says to me "Why don't you call your surgeon and have them fax the information to us?" Okay why didn't you ask me MONDAY to do that instead of making me wait until the end of the week? Called surgeon's office gave office secretary info hopefully it will be faxed today but being almost closing time probably not until Monday. So HOPEFULLY I will know something next week. M:violin:

[3loves 0]

I really think some companies actually teach stall tactics!! Can anyone with experience in insurance confirm or deny this? Why didn't she tell you that on Mon...was it the same rep?

Do you have a fax? If so, ask the office to fax it to you when they fax it to insurance then call insurance. Sorry to ask so many questions. :phanvan I am frustrated for you.....hang in there!! :biggrin1:

[Mvpo8961 1]

Hi 3loves. Let me tell you the short version of my ins story. Had Cigna so I had to do a six month dr supervised wt loss program. Started program September 2005 after having husband (who carries the ins) check with human resources coordinator to make sure it was a covered benefit and it was. November 2005 open enrollement for next years insurance. Had husband recheck to make sure still covered and it was. Started all my preop stuff like psych eval nutritionist and still seeing PCP monthly. December still nagging feeling about CIGNA recheck yet again with coordinator and told covered benefit. Middle of January asked HR coordinator to see it in WRITING where it was a covered benefit and not just her word it was. Couldn't give me a written policy. By now it is the end of january and I finally wised up and called CIGNA myself and was told IT WAS NOT a covered benefit. Talked to HR coordinator told it was. I called CIGNA again told was not. Hr Coordinator called CIGNA and was told is was NOT a covered benefit. BUT by now it is JANUARY 31st at 4:00 PM and HR closes at five. The good news it is the LAST DAY to change insurance for the following year. Hubby hurriedly calls ME to get his signon and password to go into his account and change to UHC which specifically prints in THEIR plan the WLS is a COVERED BENEFIT. My husband says I am a bulldog cause I just wouldn't let it go and kept digging, digging digging. I had already obtained financing for private pay but I now had a chance for insurance to cover it. Whew!!!

So had to wait two weeks for temporary insurance cards to give to the surgeon's office. Did that on 2/13 and the first letter/packet of PreD was sent off. Called insurance co on 2/21 was told it was received on 2/20 and was being processed. Guess what sucked into that cosmic black hole cause it was never seen again. Three weeks later second letter/packet FAXED and received on 3/6. Sent to predetermination dept 3/9. Told 3/20 letter sent to surgeon about facility name. Talked to ins Friday 3/24 and asked to call surgeon's office to have that FAXED to them. So that is why I call everyday because you just never know what's going to happen.

Hee. Hee. The service reps know who I am for sure now. But I have a good feeling about this week. I don't think they would want to know the name of the facility to be used if they weren't going to approve me. Talked to my surgeon's office Friday and they were going to fax that info so I am hoping by Tuesday it will have gone to whoever needs it and I will have an answer. M:clap2:

[ReneBean 3]

Hugs Mypo.

I can tell you that it pays to be a bulldog... I had to fight for a full four months to get my insurance coverage - I appealed and finally got an independent medical review by the State Board of Insurance...

In the end - Insurance paid for it all... My total out of pocket was less than $500... TOO AWESOME!

Keep your fingers on the phone keypad and remain calm. It will happen for you, too. Keep fighting.

:]

[Angels 0]

Very same battle with M.D.IPA (United Healthcare), received different responses from several customer serv rep for the same question. I was so frustrated and could not sleep that I wrote a letter to the CEO, Mr. Thomas Barbera regarding this matter and how he needed to re-train his employees and how they should know each step to advise patients on all of their covered benefits. I had to remain a bull dog and call each day and finally the surgeon's office called me and informed me of the approval. You would think since I spoke with M.D.IPA just about everyday and they had it documented on their system, they would have called me but that is okay because what the LORD has intended for you no man on this earth can take it away!! Surgery date is April 4, 2006, please keep me in your prayers and I will do the same for you all.

[maryb 1]

Call them everyday and bug them, so they will pay to get rid of you!

[Mvpo8961 1]

Thanks everyone you can be sure I will stay on it like a BULLDOG!!!!!!!!

RB how are you doing? Have you been back to Dr. Fox for your followup? How did that go? M

[3loves 0]

You know, we call that "grit" where I come from. Never surrender!! That's a good attribute to have. Some people take it too far and become rude, but I can tell that's not you. You just make things happen. :biggrin1: Perhaps that will be the difference between and "yes" & a "no".

This I know for sure, you are going to appreciate your band sooo much and will be sooo thankful. I can say that from my personal experience.

I read something I can't get out of my mind that PhotoNut wrote....."God's timing is perfect".....or something to that effect. I keep reminding myself of that and think of all the people that have been at this for a year or so.

I fully expect a "yes" as you do. Let's keep on keeping on and lean on each other!!!

[nanahanna 1]

Hang in there MVPO! I go to Shreveport Tuesday for another seminar (required that I attend THIS surgeon's seminar). May 2nd or shortly thereafter should know if I am getting lapband or RNY...'cuz if LA denies lapband for medicare patients I am getting RNY and thats that.