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m_kuiphoff

By m_kuiphoff, in Insurance & Financing

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m_kuiphoff    1

m_kuiphoff
Posted

I started seeing Dr. Kollar a year ago this past Dec. Started out thinking to go the lap band route but when I saw him in Oct. we decided to go with the sleeve. I'm 5'4 216lbs, my BMI is 37.1. I have at least 4 comorbidities. Also had psych eval and consults wiyh dietician. I have a letter of medical necessity from my primary and I also have two more one from my back Dr. and the other from my vascular. I have chronic venous insufficency. I'm at a loss.

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trekker954    421

trekker954
Posted

My surgeon's office called late Thursday and said they are still missing the psych eval (he promised to send it out before Christmas); I'm so mad and of course have to wait until Monday to get someone in the office there. The nurse also told me no labs which I had done last monday at Quest. I stopped by this morning and they looked me up and said not finalized. I asked why when typically Quest gets reports back in a day, two at most. They said because it had to do all those test on the Vitamins and such. It was really a long lab list. So hopefully that will be this week sometime. But they only need to psych for the insurance, the labs are just the pre-op. I don't want to schedule the endoscopy until BCBS says they'll be paying.

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trekker954    421

trekker954
Posted (edited)

So they drag my psych out of his surgery recovery and he tells his staff where to find the eval that he did in fact send to Cleveland clinic, my surgeon the day of our meeting. So she refaxed the one that showed it was already done. The surgeon staff confirmed they got it, but didn't apologize for losing it or whatever.

She also said she's not sure I will be approved after all of this, because my BMI hasn't been 40 for over two years. and while its been over 37 most of my life, I only have co morbity evidence for 2015, not going back two years. That isn't at all what the eligibility states for BCBS Fep.

I also just Saturday received my official letter from the surgeon dated Dec. 11th, the day we met. And he said he was removing my gallbaldder, yet that was missing from the surgery plan.

Although my surgeon is suppose to be one of the best, one that fixes others mistakes, I'm losing faith in Cleveland Clinic. They just seem soooooooooooooo disorganized there.

Edited by trekker954

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rgallardo    30

rgallardo
Posted

Oh my goodness I'm so sorry I would totally be frustrated I sure hope they approve u... Having a bmi of 40for over 2 years is ridiculous....... I have no medical documentation before I started everything except for a uti... My insurance did not require 2 yrs of showing my bmi..... I sure hope they approve it anyways

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m_kuiphoff    1

m_kuiphoff
Posted

Well here we go again.....I have two friends that have had the procedure done over the Xmas break. They both went for their follow ups yesterday. Mention me to the coordinator. Coordinator told them insurance has my information but probably has'nt seen it yet because of the holidays? She told them I should call the insurance back in a week or two? I think I'm going to call the office and find out what day the information was actually sent out.

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Careysgirl    20

Careysgirl
Posted

I would call ur doctors office back and let them know what ur insurance is saying so they can refax it..... I'm sure they did fax it.... It's just so many offices either has someone miss place taxes or some are electronic faxes and will show sent on one side but won't come through on the other..... I'm saying this from experience I also do authorizations for a living and at times a gotta fax things several times..... So definitely call ur dr again and just let her know that u spoke with ur insurance and they claim to not have received it would u mind refaxing it.... Sometimes we gotta be persistent to get our stuff done right......best of luck please let me know how it goes

So what if, when all the information and notes are collected, we tell the doctor's office to give us a copy for our records and fax cover sheet they send (we should be allowed to get it because it's our medical records) and keep it just in case the doctor's office takes their sweet time to send it or something else happened that's causing a delay. If that happens then we can always fax over the info to the insurance company. Is that possible?

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rgallardo    30

rgallardo
Posted

I don't see why not...... Some places charge for copies but if uwanted them I don't see why they wouldn't give u them or have u sign a release of records........ As far as fax cover sheet I'm not sure depends on companies policy since its their information on it.... Doesn't hurt to ask them

I would if they don't get to the bottom of it ask for a supervisor that's just crazy long

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rgallardo    30

rgallardo
Posted

Well here we go again.....I have two friends that have had the procedure done over the Xmas break. They both went for their follow ups yesterday. Mention me to the coordinator. Coordinator told them insurance has my information but probably has'nt seen it yet because of the holidays? She told them I should call the insurance back in a week or two? I think I'm going to call the office and find out what day the information was actually sent out.

I would seems u been waiting way too long if something don't happen soon I would ask for a supervisor

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Wonderkind    23

Wonderkind
Posted

Well here we go again.....I have two friends that have had the procedure done over the Xmas break. They both went for their follow ups yesterday. Mention me to the coordinator. Coordinator told them insurance has my information but probably has'nt seen it yet because of the holidays? She told them I should call the insurance back in a week or two? I think I'm going to call the office and find out what day the information was actually sent out.

well that's a huge HIPPA violation!

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Go To Topic Listing Insurance & Financing

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      1. Selina333

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    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

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        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

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        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

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      Officially here for a long time, not just a good time💪
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