Insurance denying - Need records I can't come up with

[robs477]

OMG, OMG, OMG, That is just flippin UNREAL!!!!!!!!!! SIMPLY AMAZING!!! My girls had them shakin in their boots!!!!! I am SOOOOOOOO happy for you! I will give Diana a REALLY, REALLY BIG HUG!!!! for you, (which I planned to do anyway) when I see her in person SIX weeks from know!!!!!!!!!!!!!

 

[Larra]

AWESOME!! You did it! And I hope that miserable woman who told you that you couldn't appeal a denial because she wouldn't issue one gets into trouble for her conduct, or should I say misconduct. Just unconscionable.

 

[jas84047]

Thank you Rob, please do! I know... I was in complete and utter shock when I got the call. I almost let it go to voicemail because I just couldn't hear anymore BS. Now I just have to wait for my damn surgeon's office to call and tell me the date. The case manager told me the doc office told her the surgery was June 15th... Complete news to me?!

 

[southernlady]

YES!!!!!! As soon as you know, let us know so we can stick it on the calendar!

 

[newanatomy]

Progress!! Yay!

 

[DianaCox]

My mother likes to tell this story:

I was due towards the end of July. Dad was in the Army, and when they first married, he was stationed in Monterey CA. Mom got pregnant pretty much right away, but towards the end of her pregnancy, he was relocated to a military base in Austria. Mom wasn't allowed to go overseas until 3 months AFTER I was born, so she had to move back in with her parents in Brooklyn. It was a long, hot summer in 1953 - most people didn't have in-home A/C back then. Because she was a military dependent, she had to travel to St. Albans Naval Hospital in Queens for the birth. Needless to say, she was anxious to deliver ASAP! But no - the end of July came and went. So did the first week of August - long, hot, sweaty and uncomfortable. And then the contractions started.

Mom made three trips by ambulance to St. Albans in the ensuing 10 days, thinking she was in labor. Not only was she anxious to get it over and done with, St. Albans had A/C!! Twice, she was sent back home - false labor. The third time, the night of the 16th, she went back and decided that no matter WHAT the doctor said, she was NOT GOING HOME until I was born! If only so she could stay in the A/C. So, she had her speech prepared (remember, she was female, a military dependent with no husband around in a military hospital, 21 years old and it was 1953) to DEMAND that they allow her to stay. She was ready and loaded for bear.

The doctor walked in, did an exam, and as she got herself psyched to blurt out her demands - the doctor said "OK, this time you ARE in labor." Mom likes to say she felt like a blown up balloon (in more ways than one) that just got all the air let out of her - her whole speech, the brave assertiveness she was ready to unleash - it had nowhere to go! And I imagine that you (as well as I and Larra and a few others) feel a little "cheated" of the big Battle with the Badass Case Manager we were going to help you win!

Which brings me to part two of my ramble. One of the first things we learn in law school is "WHEN YOU ARE WINNING, SHUT THE FUCK UP." Although I would like nothing more than to immediately take that Case Manager down, hand her her ass and stuff her head in it, right now is not the time. You have your approval, so off you go to get your surgery. And if you need something to do with your pent-up anger and anxiety, start writing up a narrative description of everything that happened, including copies of all correspondence and your notes (which I KNOW you took during the conversations, wink wink) with Case Manager about exactly what she said to you. After you have surgery, and after the bills are all paid, THEN you will file a complaint with her department head and the General Counsel's office.

Revenge is a dish best served cold.

 

[robs477]

"WHEN YOU ARE WINNING, SHUT THE FUCK UP." .

Every time you speak, you ring my bell in one way or another and then I have to stop what I WAS doing and post.....! What you just said is the one most valuable lesson my corporate Attorney taught me during my business litigation. If you are winning, SHUT THE F@** UP, because you might just bring up something the judge or the other side hadn’t considered . Of course for me being like my Idol and mentor…Mr. Foghorn Leghorn, …,not passing up a perfectly good opportunity to say nothing was and still is of the highest challenge for me. Less is more in this case and many others and Ive found the same concept applicable in almost everything, 100% correct, again, as usual!!

 

[OldBroad]

What she (@DianaCox) said. Especially the part about "when you are winning, shut up." I had that whispered in my ear at an appellate oral argument once, as the judges were ripping my adversary's arguments to pieces. I passed on my chance to offer a rebuttal argument, since the judges had already made all my points for me.

 

[jas84047]

And I imagine that you (as well as I and Larra and a few others) feel a little "cheated" of the big Battle with the Badass Case Manager we were going to help you win!

I totally do feel like this! I had psyched myself all last night to come back to the table and demand she use the info I had given. But, she called... and ever so quietly, I might add...informed me she had "approved my surgery due to the documentation I had sent in the (last) email." I had not only sent my original email with the emails from my PCP but your letter. I still can hear her timid voice in my head telling me I was approved like she was a beaten child...LOL... and I am totally ok with knowing I did that!

Thanks again!

 

[Spiky Bugger]

My mother likes to tell this story:
Revenge is a dish best served cold.

Remember the Yard Sale Bitch across the street? The one who, every four to six weeks, was exceeding the annual yard sale limit for this town? Whose customers were blocking fire hydrants and our driveway? And I told her I was reporting her ass? And first she sneaked over here and left anonymous gifts? And I reported her anyway? Then her (very tiny...lol.) husband came over and tried to intimidate me? And then two weeks after the city contacted her, she was here ringing the doorbell and pounding the shit out of our front door, yelling and warning us to "watch out?" So then we had to have the police tell her that she should probably stop? That bitch?

Well, a few weeks later, we started getting bills from Playboy and Penthouse for our new subscriptions. They weren't even snart enough to figure out Mr. Sue's first name. We even got a (returned unopened) magazine.

When the For Sale sign goes up in front of our house, they MAY THINK that they soon won't have to worry about getting reported for yard sales. But of course, they advertise online. Which I can read from anywhere. And I probably won't have much to do when my daily house hunting is over.


I can wait for my double order of Revenge on Ice.

 

[more2adore]

YAY for being approved. You had them running scared.

 

[marissamast]

LOL! Thank you bitch... er, Spiky! Yes, a huge HIPAA violation.

Diana, we are a self funded plan so I realize that makes things even more difficult. I have the full document but there is Nothing regarding bariatric surgery other than it's an exclusion. We just got the bariatric surgery rider added to the employees plan 2 years ago so I know it's covered... however small amounts. I was given nothing in writing directly from the insurance or case manager about my pre-requisites. The paperwork I got from my surgeons office mention Nothing about this 6 months of records showing at least 3 visits without anty gain in the last 2 years. I will admit I did not call the insurance at the beginning of this process and realize that was dumb of me to just go by the list my surgeons off gave me of requirements. I should have known not to trust one person. :/ Plus I really don't have anything to appeal since it technically hasn't been denied yet. They just said they "can't approve my surgery until I send in that other documentation".

Oh Lord. Welcome to Utah. So sorry....but I think Diana had a great idea...submit your weigh ins from the last 3 months.

 

[marissamast]

Haven't heard back from my insurance case manager yet although I know she has read the email. Feeling very anxious...

Got a horrible email back from my surgeon's office "insurance specialist" (because she is far from a specialist)... She started it off with,
"First of all please do not yell at me or threaten me, that is not a good way to proceed through this process. I know you are frustrated and upset, I agree with you, but we/me are not the bad guys here. This is coming straight from your insurance company. According to what records I have you do meet the criteria that is why I sent it on to your insurance."
I haven't actually talked to her just left voicemails and emailed because she never calls me back. I never 'yelled' or threatened her or the surgeons office, I only explained my frustration and mentioned the possibility of getting an attorney to help with the case/appeal. I replied back (because again she doesn't take phone calls) and explained I didn't mean to come across threatening or yelling but now I'm worried my whole surgery is at risk.
Feeling really down.

I was going to go with Cottam originally for my surgery and due to the ignorance and complete incompetence of his staff, I chose not to even go to my first appointment (Thank you Jesus) and went to Rocky Mountain where I got a proper DS. I have BCBS so I could go to either place, I have not heard good things on these web sites about Cottam...what about the U? They have a great program there too. I started there but had to go to Rocky Mountain because they didn't have their Certificate of Excellence required by BCBS.

 

[hilary1617]

Congratulations!

 

[jas84047]

I was going to go with Cottam originally for my surgery and due to the ignorance and complete incompetence of his staff, I chose not to even go to my first appointment (Thank you Jesus) and went to Rocky Mountain where I got a proper DS. I have BCBS so I could go to either place, I have not heard good things on these web sites about Cottam...what about the U? They have a great program there too. I started there but had to go to Rocky Mountain because they didn't have their Certificate of Excellence required by BCBS.

@marissamast , You are correct. Cottam/BMI's staff is beyond incompetent. If I hadn't already fulfilled all my requirements with them and I could actually get a DS with my insurance I would've switched to RMP. That being said, I do like Dr Cottam as a surgeon and have heard good things about him and Dr Richards. If I could just light a fire under his staff the whole experience would be much better. Finding out I was finally approved Thursday morning and then being told my paperwork now had to go to the office clinical review and then to the scheduler before they would talk to me about a surgery date is beyond frustrating! I got an email stating to "please be patient as this process could take up to 5 business days". Um....??? What more clinical info do they need to review if they had to send it all in to the insurance in the first place? And why would finding a date in the schedule take that long?! I'm annoyed to say the least. But ever since the insurance lady told me she felt I threatened and yelled at her (I've never actually spoken to her) I've decided to sit tight -- but only for exactly 5 days!