OK, I have been trying to get approved since March. Finished my 6 month supervised diet and everything then. Well the insurance coordinator at the surgeons office called the insurance and found out there was and exclusion on my policy, to make a very long story short I was getting the run around from the office staff and finally in at the end of June they just got tired of me calling and said you can only proceed as a cash patient call back when you have the money, basically.

I got the financing ready to pay cash, have final consult with surgeon, he said why were you denied? I said I wasn't your staff never sumitted it to the insuance due to an exclusion, he and I go to the insurance coordinator that works for him and he said with all this stuff, she has many co-morbities submit it to her insurance before she pays cash and see what they say, I will do a peer to peer if necessary. She then tells him "there is an exclusion..." he says "submit it any way all they can say is no.." she is again hesitant and he sternly says "SUBMIT IT TODAY". This was three weeks ago Tuesday, she calls me the next day and says its all ready to go, I'm mailing it in because you have alot of records (I think" I know I got them all and brought them to you because you wouldn't request them").

Fast forward three weeks till today, cannot be patient any longer, I call my insurance to see what decision they had made. They say we don't have anything on you, haven't seen anything. I then call the coordinator, tell her the insurance hasn't seen my pre authorization claim yet, she tells me oh I'm sorry, I haven't gotten around to sending it in yet, I'll do it today. I about came unstuck. When do you cease being nice, I really really like the surgeon and I don't want to go to anyone else, but I am having a very hard time with everyone else in his office, and the most frustrating part is I have the cash but if I don't have to pay out $17,000 on the off chance that my insurance will pay for it I can't help but try!!! And after my consult with him I don't think he has a clue as to what his staff is up to! :biggrin:

Thanks for letting me vent, I'm about to the end of my rope and getting ready to say forget it.

You might have to find another Dr. He obviously is not in control of his staff. That won't change if he did your surgery. My Dr. only employs nurses and staff that have had the surgery. They all understand the issues that we are facing.

Keep your chin up and find a Dr. who will take you seriously. Many Drs. are in this business because they want to make differences in peoples lives. He must not because of who he employs.

My band has enabled so many wonderful changes to happen. I am in control of my life again!!!

Good luck!

Girl! There is a time when enough is enough! Since the doctor already approached his staff and demanded to try, its says he has your best interest at heart. However, the lazy coordinator is a slacker. I would go straight to the doctor. I would write down each time you had to do research, call the insurance, and also include his visit the date, etc. and then let him know that she "forgot" to submit the paper work. She seems like a bitch.. excuse my language.. LOL... But if I was there I would go do it for you. :biggrin:

I would make sure the doctor is fully aware of what the staff is up to.

please share the name of the clinic/dr. The state at the least!

can you e-mail your doctor. i know my doctor has an e-mail adress that i can e-mail him at whenever i have a question.

OMG what a headache for you! Makes me so grateful to be an Australian where we have a national health system who will pick up some when the Private health providers finish (no evaluations needed) Then through our tax system I can claim back any out of pocket expense over $1500 that includes pharmacuetical, optical, dental, pathology etc etc. My GP gave me a referral to WLS doctor and I went for consultation, he told me that it would cost approx $7000 all of which is claimable one way or another and asked then I'd like the op. I could have had it 2 weeks later if I chose, but to fit in with my job it suited me to wait till my break was due. All follow up appoinments for check-ups or fills are of no extra expense as the government health system covers it.

GOOD LUCK WITH YOUR EFFORTS. Dob the staff member in and hopefully the doc will throw the book at her.

This sounds JUST like what happened to me. Then when she did submit the paperwork she only sent in half of it! Well of course I was denied. I just got all my stuff together with a letter and faxed 25 more pages of records that for some reason she failed to send. I am doing all the leg work as of now. If it were not for the fact that I like my surgeon I would have gone postal on the "surgery coordinator" already. Sometimes it is best to be your own advocate, seems in toadys world you have to. I too have had to bite my tongue, but in the end, she will know I how feel!! Good luck to you! Tamara

I am going to contact the doctor, he was wonderful. I didn't want to be a tattle tale on his staff and seem like a whiner but he did look at me a little funny when I handed him a folder an inch thick with records so I kinda eluded to the fact that I was getting the run around. But this is the last straw. I'm going to throw them under the bus this time if I were the surgeon I would like to know how my patients were being treated. I just wonder how many other people have gone to other surgeons because they don't want to work on the cases that might be out of the ordinary.

The surgeon is in Las Vegas, Nevada. Thanks for all your support, I'm not nearly as mad as I was yesterday, I didn't even break out the Cookies.

I'm not nearly as mad as I was yesterday, I didn't even break out the Cookies.

Good for you!! Don't let her get to you. You should not have to lose your surgeon because of an employee who's out to prove something. I worked for surgeons and I will tell you if one their employees did that they would have been let go. One for patient treatment and two because she's actually taking money away from the practice if you chose to go somewhere else.

I bet he rips her a good one once he finds out the latest because I know he has not been updated.

Also, if you do not already have one I would obtain a copy of all of your documents. Since what has been mentioned here before. If they deny you because of missing documents you will have a copy to send to them without having to deal with that woman.

I made copies of everything, I had a friend of mine get the surgery at this same office a couple of years ago and she warned me about how this staff has a tendancy to "lose or misplace" records. This office is very busy, and 90% of their business is easy insurance approval. I really don't think any of them in that "patient advocate" part of the office wants to put any effort into something that might require a little extra time an energy on their part, I think they have become way to complacent and really don't care if the patients go someplace else, I'm sure the surgeon doesn't know, though he is about to...:wink2: I have made an appointment with him on Friday the 8th

I'm sure the surgeon doesn't know, though he is about to...:teeth_smile: I have made an appointment with him on Friday the 8th

That's great! Keep us up to date! I bet his expression will look something

like this when you tell him.