OH NO! what should I do?

cleanteeth · April 24, 2008

I just got the letter that my PCP sent to the surgeon's office (which was part of the fax to insurance). It said I had been on Jenny Craig (I've been on LA Weightloss for a year) it said I had knee problems I don't have, and said nothing of the pre-diabetic condition. It did include my sleep apnea and my weight loss and the weight gain. I've been with him since 2001 which he included, and he recommended the surgery. I"ve got CIGNA insurance. Should I just sit tight and see what the insurance comes back with, or should I call to correct the problems??? I need help with this one. Anyone out there had an experience like this?:confused2:

molly

Shinyhappymommy · April 24, 2008

My doctor's letter to the insurance said that I had Stress Urinary Incontinence, that I wore pads for it and it limited my social interactions. None of which were accurate. I probably marked that I leak urine sometimes when I sneeze and that's what came out of the form letter from that response. I didn't do anything about it as most of the letter was accurate and he didn't leave anything important out.

I might call about omitting the pre-diabetic condition if you think it will help. Other than that, I don't know why doctors write what they do sometimes.

Jachut · April 24, 2008

Oh, I couldnt bear to leave that, lol, I'd have to set them right on the incontinence!

Chunkymonkys · April 24, 2008

I work for CIGNA and have their insurance and honestly, I wouldn't worry about it. You've got enough going on to warrant the surgery, and they dont check up on your weight loss attempts. They just need to see it in writing. If it comes back with a denial, then I would tell your PCP about the medical condition mistake and appeal it.

You can always call the number on the back of your card and ask to talk to the prior auth department and check the status of your case. Once they receive it, they should have an answer within 5-7 days, so the wait, as long as those days can be (trust me lol) will go by faster than you know it!!

Good luck!!

Alexandra · April 24, 2008

I agree with Dollhouse; wait and see what results from this letter. Your doctors have done this before, they probably pick and choose from among the various facts available to create a compelling case for surgery. I remember reading my letter and it sounded awful! Everything in it was technically true, but I had no idea I was at death's door.

Good luck!!

cleanteeth · April 24, 2008

Thank you so much for your input. I feel better about it.. especially from dollhouse. thanks for making me feel better. Also to shiny.. you made me laugh! but didn't pee1 thank goodness!