Insurance Questions

[LorraineC]

Hi All,
I have a question about my insurance if anyone can help. I have Anthem Blue Cross and am planning on having my surgery done by Dr. John Rabkin in San Francisco, CA. Insurance approved everything, all my pre-op clearances are passed, but I am waiting on the LOA to be sent to Dr. Rabkin and Matt Williams (the insurance/financial mgr.)
I've been going back and forth with my insurance about this for over 3 weeks. They say, insurance is approved, and we'll pay 100% so schedule the surgery. Dr. Rabkin and Matt say they need the exact amount insurance will pay and they need it in writing. In essence, they won't schedule the surgery until the 12,600 fee is paid in full, which is understandable. Any ideas on how to light a fire under my insurance's behind and get them to get the LOA in ASAP? I feel like they're dragging their feet on purpose and trying to postpone this as much as possible to get out of paying for the surgery totally.

TIA,

Lorraine

 

[galaxygrrl]

No idea on that question, but Dr. Rabin's group is a week from Wed. If you are game, you should come. I find it the highlight of my weight loss journey. Here is the scoop. Dr. Rabkin is great btw

San Francisco
Date: 2nd Wednesday of each month
Time: 6 PM - Simultaneous Informational Seminar and post-op meeting.
7 PM - General open meeting for both pre-op and post-op patients.
Place: Cafeteria at St. Mary's Hospital
450 Stanyan Street
San Francisco, CA 94117
Additional details: Parking is available at St. Mary's Hospital parking at the corner of Stanyan and Hayes Street.
For more information please call our office.

 

[LorraineC]

I've been there. I was at the last one and met you and everyone! Such a great group. I'll see you Dec 14!

No idea on that question, but Dr. Rabin's group is a week from Wed. If you are game, you should come. I find it the highlight of my weight loss journey. Here is the scoop. Dr. Rabkin is great btw

San Francisco
Date: 2nd Wednesday of each month
Time: 6 PM - Simultaneous Informational Seminar and post-op meeting.
7 PM - General open meeting for both pre-op and post-op patients.
Place: Cafeteria at St. Mary's Hospital
450 Stanyan Street
San Francisco, CA 94117
Additional details: Parking is available at St. Mary's Hospital parking at the corner of Stanyan and Hayes Street.
For more information please call our office.

 

[LorraineC]

No idea on that question, but Dr. Rabin's group is a week from Wed. If you are game, you should come. I find it the highlight of my weight loss journey. Here is the scoop. Dr. Rabkin is great btw

San Francisco
Date: 2nd Wednesday of each month
Time: 6 PM - Simultaneous Informational Seminar and post-op meeting.
7 PM - General open meeting for both pre-op and post-op patients.
Place: Cafeteria at St. Mary's Hospital
450 Stanyan Street
San Francisco, CA 94117
Additional details: Parking is available at St. Mary's Hospital parking at the corner of Stanyan and Hayes Street.
For more information please call our office.

Wait is it the 7th or 14th? Did they move it up because of the holiday season?

 

[southernlady]

Moved this to the Insurance forum.

And other than being a PITA with your insurance, no way to make them move faster.

 

[galaxygrrl]

Wait is it the 7th or 14th? Did they move it up because of the holiday season?

Oh, yes, sorry. I really enjoyed meeting you. Oh, sorry, my bad. I got the dates confused. See you in a few!

 

[Larra]

If you are not already doing so, speak with a supervisor, and keep going up the food chain until you get someone who knows what he/she is doing and will commit to getting it done. Preferably arrange to speak with the same person every time you call, i.e. make them your advocate within the big impersonal company that, let's face it, doesn't give a damn about your welfare. Document each and every conversation with name and job title of the person you speak with, date, time, their phone number, and a brief summary of the conversation. Create a paper trail, even if it's in emails, and save everything.
And if all else fails, contact the DMHC (dept of managed health care) with a complaint about them. You don't need to file an appeal because they have apparently approved your surgery. @DianaCox might know better than I how to handle this situation, but that's the best advice I can offer.

 

[LorraineC]

Thank you ladies @Larra and @southernlady. I have a feeling that I'm already a PITA, but I'm about to become a much bigger one. Calling 2x/day instead of 1 now.

 

[LorraineC]

Update: So I called insurance all throughout the week and they kept telling me that everything was processing, then on Friday, they told me that they didn't have anything, and that everything on my end needed to be sent (mind you it was sent 5 times to 5 different fax numbers all provided by CHCN employees AND I had in writing on 11/9 that someone named Rithy, a manager, had received the LOA request and was looking over it) so I basically had to threaten them and say that if my claim was not processed by Monday 12/12, I would report them to the DMHC of CA and I would call every news station and share the story of how insurance company was stalling and withholding a medically necessary procedure from a patient/paying customer who was running out of time to have it. So, lets hope that Monday brings good news for me, otherwise it'll be bad news for them.

 

[DianaCox]

If you don't hear from them by noon on Monday, send me a PM.

 

[LorraineC]

If you don't hear from them by noon on Monday, send me a PM.

Thank you, will do!

 

[galaxygrrl]

Good Luck!!!!!

 

[LorraineC]

Good Luck!!!!!

Thanks, see you on Wednesday!