Patient Advocate negativity... is this normal?

[Aggie98 0]

My paperwork should be submitted to my insurance company either tomorrow or Tuesday and I am feeling kind of discouraged because of the patient advocate at my surgeon's office.

My insurance (UHC Choice Plus) requires a BMI of 40, and weight history for the last five years, and if you don't have the 40 BMI, you have to have 35 plus two comorbidities. At my initial consult I had a BMI of 40.5 and over the last five years I don't have a 40 BMI but it has definitely been over 35. Fortunately I don't have any health problems but I know if I keep down this road I will definitely develop problems.

Anyway, the woman at my surgeon's office keeps telling me that my insurance is probably going to deny it, and is always asking me if I still want to submit my paperwork. I've heard that UHC is one of the easier insurance companies to get approval from, and I think I have a pretty good chance. Besides that, I have already spend quite a bit of money on co-pays for the surgery requirements so I want to follow through.

Is she just trying to get me to not get my hopes up or what? She has been so bad that at a couple of points during the last couple of weeks I was ready to just say "Screw it! I will just join Weight Watchers again...." Is what she is doing normal?

Thanks for your input!

[TQUAD64 9]

Wow that is beyond frustrating. I have heard via this forum that the insurance company looks at the BMI from the initial consult. I would submit the paper work and wait for their response.

If you are denied you can seek an appeal or gain enough weight to put you over a 40 BMI, so you can resubmit. I no gaining weight sounds crazy, but having this surgery is worth it.

Good luck!

[RestlessMonkey 7]

Hey Aggie...I would ask HER why she's so negative. Tell HER what you've told us. That may just be her personality, or she may have experience that tells her they are going to deny you. Only she can really really answer your question. I weighed 405 and got approved in 2 days with no comorbidities, so I'd say "NO that's not "normal" but that doesn't really apply to your situation.

Call her Monday and ask her. If she's just negative by nature, then blow her off. But she may have been denied by the company for cases similar to yours; in which case you could ask her what to do to appeal!

[babbs3772 1]

Quite frankly I would be a bit ticked off, if she is being insensitive because of her own issues she should keep them to herself - she is not in business of complaining but of the helping profession.

:tongue2: now that being said I would be pro- active and frank with her, ask her if there is something going on that she needs to discuss as you are feeling like she is not being supportive and you need her to be - particularly because she is a patient advocate! <--------key word here!

If you don't have luck that route then I would consider speaking to someone else who has some clout in the office.

I guess this riled me up as I know what a struggle it was get my insurance to pay and what a long hard road it was to get my band - I hate to see anyone in a position that makes them sad or frustrated.

Barbie

Edited January 12, 2009 by babbs3772

[Band_Groupie 3]

This is from someone who hasn't been approved yet, so take this with that knowledge. The insurance person at my surgeon's office deals with the insurance co.'s every day. At my seminar she knew each person's insurance co. and gave us handouts on specific requirements. She knew which ones were easy to deal with and which ones aren't. If your gal works for the hospital, her job is to work to get you approved, if she's telling you she thinks you'll be denied, I'd take it as truth...I think she's just telling you like it is. Instead of asking why, maybe ask her what you would need to do to get approved...even if it takes a few more months/years...it's better than giving up completely.

[Aggie98 0]

Thanks for all your replies!

I am not generally an overly sensitive person or someone that needs to be coddled all the time but her attitude really IS frustrating. I just feel like if she felt like my circumstances would make me unlikely to be approved, maybe she should have told me this BEFORE I spent money doing everything on my end to get ready for the surgery. Oh well, I will just keep plugging along and hope that I get approved! Several people at my job have had the surgery and all had an easy time getting approved with varying circumstances with their health. Hopefully it will be the same for me!

Edited January 12, 2009 by Aggie98

[MacMadame 81]

If your gal works for the hospital, her job is to work to get you approved, if she's telling you she thinks you'll be denied, I'd take it as truth..

Except plenty of people have been approved with UHC with a BMI of 40.5 and not even supplying 5 years of weight history.

So I'd take it as her opinion, not the truth. I'd also ask her why she keeps asking you if you are sure you want to submit. That part is very weird to me. If she think you need to do something else before you submit, she should say what it is. If she thinks you'll be denied, she should say she's going to submit, but she's not hopeful. But "are you sure you still want to submit" is IMNSHO passive-aggressive bs.

[Aurelia 2]

I have this same issue with the patient coordinator at my surgeon's office. She went as far as telling me she would submit my paperwork and after a month of not hearing a response I call UHC and they tell me nothing was sumbitted. I called the surgeon's office mad as hell and she said she would submit it but doubts it will get approved and it would take at least 30 days to get a response.

Guess what? It was submitted on monday and I got my approval by friday. You can imagine the things I want to say to the patient coordinator.