Insurance Issues

[FireEMT710 43]

My insurance has denied my surgery twice. Once because there wasn't the PCP doctors letter in there, though they had it. So they resubmitted it. I'm not sure why it was denied this second time. I called them friday morning and they said my dr office could set up a peer to peer with thier medical director.... so my insurance called the doctor office and set it up. Anyone ever have problems like this? I mean my BMI is near 45... that alone should qualify me according to my work insurance!

[AZhiker 2,252]

I had issues like that - the doctors office lost both my cardiac clearance letter and my psych eval and then tried to tell me that I never had them done!!! BUT...... I had the copies!!!!! (KEEP COPIES OF EVERYTHING!!!) So it was resubmitted and then there had to be a doc to doc call. But it eventually worked out and I had the surgery. I don't think it is uncommon to have glitches. There are so many bases to cover in the process, that it is actually quite amazing if a surgery gets approved withOUT a glitch of some kind. Hang in there. It will happen.

[FireEMT710 43]

I talked to my doctors office's insurance lady today. She said she hates my insurance. lol Anyway, after the initial insurance paperwork didn't have the letter from my PCP, they resubmitted everything with the letter. They denied it because it wasn't in the initial one and is making them do a peer to peer. It's scheduled for tomorrow at 245 central time, and she told me that she would let me know as soon as she knows. Also, my surgery is still on schedule, which is fantastic news because day 1 of preop is today!

Edited November 10, 2020 by FireEMT710

[Gorgonio 11]

Good luck! I went through Kaiser they have an amazing program!

[danahall5885 21]

My package is ready to send off. Keeping fingers crossed!