Did Dr. Inman's office screw up my insurance submission for my REVISION to DS?

[Yvonne]

So I was terribly excited to hear my DS was approved in less than 24hrs. It was so soon she didn't have access to the approval and couldn't fax it to my surgeon's office, but she did give me a number that the surgeon's office could call and get it faxed. That was Friday. I called Coleen, the office manager who has been the most responsive to me, and today is Tuesday and I haven't heard a word from her. I've been told they only work 1/2 day on Friday's, but am not sure.

I called insurance today and she was able to get my approval faxed over to Coleen's personal fax number around 1:00 today. She also mentioned that it was mailed on October 16th, but I have not received it as of today. In the process of our discussion, she said that my "procedure" was approved. I asked her if she could give me the medical code number(S) (not sure what it's called) and she only gave me ONE, #43845. For the DS only!! When I inquired if there were another for the removal of my band she said they only submitted for one procedure, the DS. I tried calling around 3:30 to see if she got it and there was, of course, no answer.

I asked her if this was correct and to get right back to me. I sure hope she calls by tomorrow. I'm a little upset, as in angry. Does this sound right @Larra and @DianaCox ?? If not, I wonder how hard it's going to be to get it approved on it's own? I thought i would have a better chance with the DS procedure.

 

[Larra]

I think you need to talk to the office staff (and I know you know this and are making every effort to speak with the right person) but if anything, I would guess that it would be easier to get approval for the band removal than for the DS. Either that, or Dr. Inman is going to do that as part of your DS. I don't know how she handles this, but her office staff should know.
Hang on to that approval! Whatever you do, don't let anything happen to lose it. We've seen other people get approval for band removal easily and run into a brick wall on the DS part.

 

[Yvonne]

When I was at the other surgeon's office, getting approval for the band removal was the worst part because they said "although I couldn't tolerate it, there was nothing functionally wrong with it and they wouldn't pay to have it removed". That's what really worries me. I will call every day. The thing is Dr. Inman specifically told me that if they didn't approve the band removal she'd do a scan (geez, I can't remember what it's called) where they look through the skin to see if there is problems with the band's placement or maybe erosion - not an endoscope as I had one of those. I really feel sick. I would just like something to go smooth for once. Ya know?

 

[Larra]

That was the idiot staff at the other surgeon's office, right? I know you have already hit so many bumps in the road and it just gets more upsetting every time, but I'm really hopeful that the staff will have an answer for this one. So many people are having bands removed these days hat they must have run into this before. Hang in there!

 

[Yvonne]

Thanks. I am just getting so tired. You know? I'm not giving up, but due to all the money we've thrown in this (the other surgeon made us pay for all our other stuff long before we were approved), that we're now having a bit of a hard time with money. I just can't understand how they sent me specifically to the REVISION person and they "forget" to send in the band removal?

 

[Yvonne]

Yes, that was with the other idiot staff! LOL

 

[DianaCox]

I also suspect the band removal will not be that difficult, but SHEESH! Why wasn't that procedure submitted with the precert request for the DS??

 

[Yvonne]

Well, I talked to a woman who has the DS and she had a lap band removed as well AND she is a medical coder for surgery. She said that it was done right and what will happen is Dr. Inman will add modifiers to her bill saying she took extra time to remove scar tissue and take the band out. That's exactly what this other woman's surgeon did and she's sure that's what's going on with mine. She said she sees it all the time and it gets paid that way. I'm still bugging them until they call me to confirm that and they should be getting me on the schedule, pronto for pre-op testing/physical etc.