So frustrated

[Mommy23 0]

I am beyond frustrated right now with my surgeons office. I have met all of my insurance requirements, including the 6 months of dr's visits, psych eval and nutrition counseling. However, the surgeons office keeps finding reasons not to submit the paperwork for approval. First it was 'you need to meet with a therapist' so I did. She recommended that I follow up with her as needed after surgery and that I attend a workshop sponsored by the hospital (read a money maker). Fine, I registered for the workshop. The problem is it doesn't start for a month. So I disputed with the office that it was only a recommendation, not a requirement and that shouldn't preclude me from being approved. Last week they said that it would be submitted. I called insurance today to check on status, they told me they don't have anything. Called office back and was told they decided it needed to be presented at the review committee again. WTH? The therapist that I met with also told me that about 75% of the patients that come through for psych evals are referred for further evaluation. That seems to be a pretty high number to me. Oh, and the only psych history I have is mild depression that is controlled just fine with medications.

Has anyone else had a similar experience?

[KinkySlinky 3]

What is the purpose of a review committee? A review committee at your surgeon's office?? Sounds to me like that they are just trying to rack up insurance claims if everything else checked out on your psych exam... Maybe they aren't happy with the amount that the insurance pays... I'd let them know that I would be finding another surgeon and ask for all of your medical records so maybe you won't have to go through the same stuff at another surgeon's office?

[thinoneday 445]

I am beyond frustrated right now with my surgeons office. I have met all of my insurance requirements, including the 6 months of dr's visits, psych eval and nutrition counseling. However, the surgeons office keeps finding reasons not to submit the paperwork for approval. First it was 'you need to meet with a therapist' so I did. She recommended that I follow up with her as needed after surgery and that I attend a workshop sponsored by the hospital (read a money maker). Fine, I registered for the workshop. The problem is it doesn't start for a month. So I disputed with the office that it was only a recommendation, not a requirement and that shouldn't preclude me from being approved. Last week they said that it would be submitted. I called insurance today to check on status, they told me they don't have anything. Called office back and was told they decided it needed to be presented at the review committee again. WTH? The therapist that I met with also told me that about 75% of the patients that come through for psych evals are referred for further evaluation. That seems to be a pretty high number to me. Oh, and the only psych history I have is mild depression that is controlled just fine with medications.

Has anyone else had a similar experience?

Can you afford self pay? to get a loan and do this by yourself? This jumping through hoops thing is very irratating and then in the end they could deny you. . . this is why i just did self pay and yes i'm paying back like as if i bought a luxury car. . . but i got my surgery without playing the puppet. . . good luck

[seniorsleever 17]

I think at this point I would go in, demand to have it submitted, and when they say you need more review, just tell them you believe they are after more money! Maybe that will get the ball rolling. Geez! What a racket!

[Mommy23 0]

Thanks, it's good to know that I am not just being unreasonable. I called back and was told that I should know tomorrow the outcome of this meeting. I have scheduled an appt with a different health system on Friday if this doesn't go well. I am really tired of the runaround. I wish I could self-pay, it's just not an option right now.

[Oopsseedaisy 90]

I thought about switching when I didn't have an appointment with the surgeon within a month of my insurance approval. I called another doctor's office and was informed that the insurance approval would have to be resubmitted with a new facility and doctor's names on it. It could take 2-3 weeks for the new insurance approval.

Bottom line if you are getting this kind of treatment now, it would be better to switch before your paperwork is submitted for approval.

[Goofyspice 1]

Oopsseedaisy is correct.

Insurance approvals are very specific when it comes to the doctor preforming the surgery. my weightloss program is thru a huge hospital and ya they do go to a review board. Its weird I know and I don't know why specifically could only hazzard a guess.

My advice is hound them!!!! And tell them they can still put in for the review board before the classes start!!!

My Doctor wanted to wait and see how my newly diagnosed low thyroid would do with meds and after 5 weeks then submit for authorization. I just about flipped my lid especially when she just got done saying a thyroid problem would(n't) be a reason not to do surgery. So she went ahead and submitted the papers. I have had my surgery date scheduled for 4-11-11 since 3-15-11. I just had my follow up appointment today 3-23-11 (one day shy of the "5" weeks ) regarding my thyroid and other low Vitamins... and everything was normal.

by bad i didn't communicate that well. dr said thyroid would not keep me from having the surgery. Thats why i was freaking out when it looked like she wanted to wait and see how the meds worked before submitting to the review board and insurance company

Edited March 24, 2011 by Goofyspice

[karaserene1985 1]

You wouldn't happen to be from WI, going through Midwest Bariartric Solutions would you? They had the same thing for me.8 week workshop that was recommended. I did go, and got my info sent to insurance but I stayed on top of everything staying in contact weekly. I have to say the workshop was interesting and I learned a lot. I had a lot of hoops also, 7 months of NUT appts, psych eval, buy its all worth it in the end. I feel so much more prepared and ready. Everything was submitted for me and approved. My surgery is 5/24/11. Just stay strong. Sometimes the hoops and wait are worth it.

[Margaret 4]

I certainly never heard any medical person say that low thyroid would be a reason NOT to do the surgery----in my case it's a reason TO DO IT! Weird----do not like insurance requirements, etc. Never heard of a review board!

Oopsseedaisy is correct.

Insurance approvals are very specific when it comes to the doctor preforming the surgery. my weightloss program is thru a huge hospital and ya they do go to a review board. Its weird I know and I don't know why specifically could only hazzard a guess.

My advice is hound them!!!! And tell them they can still put in for the review board before the classes start!!!

My Doctor wanted to wait and see how my newly diagnosed low thyroid would do with meds and after 5 weeks then submit for authorization. I just about flipped my lid especially when she just got done saying a thyroid problem would be a reason not to do surgery. So she went ahead and submitted the papers. I have had my surgery date scheduled for 4-11-11 since 3-15-11. I just had my follow up appointment today 3-23-11 (one day shy of the "5" weeks ) regarding my thyroid and other low Vitamins... and everything was normal.