Finally Submitted to Insurance But List of Questions Returned

[Andrew0929 1,102]

My surgeon's (lousy) insurance person finally submitted my case to CIGNA. It sat on her desk for 4 days and if I'd not pestered her to send it in, she probably would have waited longer.

But, 4 days later I received a letter from CIGNA indicating they need more info. The letter stated that they needed: Admit Date (???), Surgery Date (???), Pertinent past medical history, co-morbidities, additional CPT codes and descriptions, current treatment plan, and Lab and Test results.

I don't know what the hell this woman sent in but it seems like she left out almost everything .... Very dissappointed and getting a little mad.

[ladypmendoza 19]

I have a horrible patient coordinator. She is not very friendly, warm or sympathetic. She herself has had weight loss surgery so you would think that she would understand. She would rarely respond to any of my emails and then when I would call her she was very standoffish and cold. I found out I was approved by calling my insurance company. I waited two days before calling the office and when I did I asked to speak directly with the Dr. I received a phone call from the patient coordinator within the hour to schedule my surgery.

It's so unfortunate that you are going through this during a time that can cause so much anxiety all on its own without the extra issues. I would call the dr. directly and see how he/she handles it.

What dr. and what area are you in?

[joatsaint 2,814]

I agree with ladypmendoza, call your doc directly. He's not going to be happy if you go to another doctor and he loses out on a $15k payday because one of his employees isn't doing their job.

A friend had the same problem. Her patient coordinator wasn't returning calls and not turning in necessary paperwork. She spoke to the doctor and said she was considering going to another surgeon because of the delays in the process, next day, things magically cleared up and she was all set for surgery.

[Andrew0929 1,102]

I agree with ladypmendoza, call your doc directly. He's not going to be happy if you go to another doctor and he loses out on a $15k payday because one of his employees isn't doing their job.

A friend had the same problem. Her patient coordinator wasn't returning calls and not turning in necessary paperwork. She spoke to the doctor and said she was considering going to another surgeon because of the delays in the process, next day, things magically cleared up and she was all set for surgery.

I'm hesitant to threaten to go to another surgeon because I think that mine is the best in my area. I'm very comfortable with him and am confident that he'll do a good job.

One reason why I'm in a hurry is that we've met our yearly insurance out-of-pocket amounts and I'd benefit greatly from getting this done before year-end. Also, our insurance is going to be worse next year (higher premium for worse coverage), so I really need to do this before year-end. I left a message for the insurance coord., mentioning all of that, and that if this doesn't happen until next year I may not go through with the surgery. Not true, but thought that might incent her to get moving ....

[ladypmendoza 19]

I wouldn't threaten going to another surgeon just yet. I would just call and speak directly to the doctor. That's what I did and he was very understanding and I was scheduled shortly after. He may not know what's going and on and can't help unless you tell him. They are much more proactive if they know; besides they don't want to lose a patient or the money for that matter.

[Andrew0929 1,102]

I wouldn't threaten going to another surgeon just yet. I would just call and speak directly to the doctor. That's what I did and he was very understanding and I was scheduled shortly after. He may not know what's going and on and can't help unless you tell him. They are much more proactive if they know; besides they don't want to lose a patient or the money for that matter.

I was pleasantly surprised to get a call from my ins coordinator this morning. She said that Cigna automatically sends out that letter to everyone even though all their requested info was sent in. She said they have everything they asked for and it is in review.

Let the waiting begin ...

[ladypmendoza 19]

Congrats!! The waiting is probably the hardest!! Good luck and keep us posted!

[Andrew0929 1,102]

My insurance co approved me yesterday. I think I'm excited. Actually pretty scared all of the sudden.

[ladypmendoza 19]

My insurance co approved me yesterday. I think I'm excited. Actually pretty scared all of the sudden.

Congratulations!! I was scared for the first few days but once the news actually sunk in I couldn't help but be excited! What's your surgery date?

[Andrew0929 1,102]

Congratulations!! I was scared for the first few days but once the news actually sunk in I couldn't help but be excited! What's your surgery date?

Thanks! My pre-op appointment with the surgeon is 11/4 and they'll be scheduling a surgery date. I'm told they schedule out 2 - 6 weeks. Looks like it'll be happening something between Thanksgiving and Christmas ...

Do you have a surgery date?

-Andrew

[ladypmendoza 19]

Yes I do...November 26th, two days before Thanksgiving!! I start my pre op November 12th, which happens to be my sons 15th birthday. I couldn't have chosen a better time but I think the sacrifices will pay off in the end. I am just trying to stay positive and think about how I will be celebrating a year from now. I will say that my anxiety has not gotten any better especially as time gets closer and closer. I am looking forward to my journey and I know in my heart this is the best decision for me and my family. I want to be around as long as possible and currently I have been told by my physician that I am pre-diabetic and that is something that I am terrified of . We can't allow our fear get the best of us especially because I truly believe that is probably one of the reasons we are where we are. We both will do great and I look forward to our journey together. Please keep me posted and I will do the same. I have my pre op appt. on November 8th so I will post more on my progress and I hope you do the same. In the meantime, if you have any more questions, please do not hesitate to ask and I will do my best to answer.

[Andrew0929 1,102]

One thing I'm having a rough time with is who to tell about my surgery. So far, I've told my wife, daughter, 2 siblings (out of 4) and 2 friends. One friend has been trying to talk me out of it since I told him but everyone else has been supportive.

Still not sure what I'm going to tell my boss. I thought of saying I'm having hernia surgery, but then I'll have to lie when the weight loss starts. Also, I'm close friends with 2 people at work and hate to lie about all this, but still feel awkward talking about it.

My boss is a busy-body and she told me about someone else having weight loss surgery (and she wasn't supposed to tell anyone). I thought of telling all 3 of them and telling them they are the only ones that know, so that they can talk amongst themselves instead of to others if they feel that need. I dunno ...

Also, hesitant to tell my mother beforehand as she is so full of bad advice. I could picture her begging me not to do it and calling daily about it. She could go the other way, but just not sure. If I'm on the liquid diet on Thanksgiving, that will difficult to explain ...

What's your plan?

Andrew

[ladypmendoza 19]

I have only told the people in my immediate circle that I felt needed to know which consists of my husband, 3 children, mother and father. I have purposely done that because I did not want any negativity coming my way. I do have a very very good friend of mine that I shared the information with because she has gone through my journey and has been very positive. As far as work is concerned, I have only told them that I have to have surgery and thankfully no one has asked me for what as of yet. If you and when you tell them you are having surgery, if asked just say its a personal matter and that you will discuss it when you feel ready to (if you feel comfortable with that); that will be my response if I am asked.

I was also very much like you, not sure what to tell people. I have decided not to tell my husbands side of the family because weight has always been an issue with them and they are always criticizing me for being so heavy. I do not feel like I will be getting the support I need from them so I have told them that I have to have hernia surgery (many have used this idea) and that I am looking forward to it so that I can finally start exercising and losing weight. I am also going to start "dieting" a few days before my pre op diet and state that I am starting a "diet" for weight loss. I am also hoping to return to work in about 3 weeks after my surgery; I have a desk job which does not require lifting. I am hoping that since I am not out of work for too long people wont notice an extreme amount of weight loss. I know it sounds like wishful thinking but my hopes are that I am ready to discuss openly after the fact.

As far as your mother is concerned, honestly, I would hold off telling her until you are closer to your surgery date. My mother was not so happy about it when I first told her so I asked her to respect my decision and to please keep her opinion to her self (respectfully). She hasn't said much since but has told me she will be there the day of the surgery and will help me after.

I am a little concerned about thanksgiving because I will only be 2 days post op and definitely be on liquids only at that point so I am just going to say that I had a reaction to the anesthesia and the doctor told me to stay on liquids for now. You could tell them that you have a stomach virus and are not feeling very well so you are not up to eating then sneak in your liquids in between. I know the lying sounds horrible but unfortunately it's all we can do ensure our personal experience stays as positive as possible.

I hope this helps. Keep me posted and we will get through this together!

Patsy

[ladypmendoza 19]

One thing I'm having a rough time with is who to tell about my surgery. So far, I've told my wife, daughter, 2 siblings (out of 4) and 2 friends. One friend has been trying to talk me out of it since I told him but everyone else has been supportive. Still not sure what I'm going to tell my boss. I thought of saying I'm having hernia surgery, but then I'll have to lie when the weight loss starts. Also, I'm close friends with 2 people at work and hate to lie about all this, but still feel awkward talking about it. My boss is a busy-body and she told me about someone else having weight loss surgery (and she wasn't supposed to tell anyone). I thought of telling all 3 of them and telling them they are the only ones that know, so that they can talk amongst themselves instead of to others if they feel that need. I dunno ... Also, hesitant to tell my mother beforehand as she is so full of bad advice. I could picture her begging me not to do it and calling daily about it. She could go the other way, but just not sure. If I'm on the liquid diet on Thanksgiving, that will difficult to explain ... What's your plan? Andrew

Hope all is well. I started my pre op diet today and have made it through. It consists of 3 Protein Shakes a day. I can also have chicken broth, sugar free ice pops and sugar free Jello.

[Andrew0929 1,102]

Hope all is well. I started my pre op diet today and have made it through. It consists of 3 Protein shakes a day. I can also have chicken broth, sugar free ice pops and sugar free Jello.

I hope you're doing ok with the pre-op diet. I start mine 1 week from today and am not looking forward to it. I've been sampling Protein Shakes and so far I hate them all ....

I told my boss and a few co-workers that I was going to be out for surgery due to a hiatal hernia, which may be partially true. Had an upper GI and it was inconclusive as to whether or not I have one and my surgeon said if he see's one he'll just repair it. So, I'm going with that, for now ...

I'm pretty nervous about the surgery. How are you holding up?