Amey
Well-Known Member
- Joined
- Jul 15, 2015
- Messages
- 230
I thought I would update everyone on the on-going saga of Project DS. Kristina at Dr. Simper's office didn't actually get the papers sent to my insurance company until Friday (the 6th). I had asked her to hold off until I got an answer from the Department of Insurance on how to proceed as I didn't want any paperwork technicalities screwing everything up. On Thursday I got the answer from the DOI that Blue Cross said that as long as the procedure code was EXACTLY THE SAME then it shouldn't be a problem to assign the surgery to a new provider. And Blue Cross had assigned a supervisor from the Appeals and Grievances department to me to be a point of contact. I was given her personal phone number and extension. She told me to have the papers faxed directly to her so that she could personally direct them to Medical Management (department that makes the decisions) and would keep me updated on the process. (Side note....it's amazing how the insurance company representatives that were complete jerks 4 months ago are now dripping with sugar and bending over backwards since the Department of Insurance got involved.) So Kristina sent her paperwork on Friday and I faxed my own letter stating specifically the reasons why I didn't feel comfortable with Dr. Medvetz and wanted to change surgeons. I was told it would take 2 business days for Blue Cross to make the decision.
So yesterday I got a call from the ombudsman at Blue Cross. They wanted a letter or an email stating why I wanted/needed to go out of state to have the surgery. They requested the email within 2 hours. I know there are no surgeons in Idaho that do the duodenal switch. The only one that did do it retired two years ago and he was an ass, but I called both hospitals in Boise and got the names of the bariatric surgeons practicing at their hospitals and then called their offices to verify that they don't do it and put their names, phone numbers, and hospitals in the letter. One doctor said he might start doing it in 3 years. Pfft. AND in the letter I had to write that I wanted the authorization with Dr. M VOIDED so that they could process the request for a new surgeon. However....I was assured that the authorization wouldn't be voided until they could make an approval on the new surgeon's request. Voiding that authorization scared me to death!
This morning I checked the BC website and Dr. M's auth said VOID and Dr. S's auth said Pend. I was freaking out! I called the ombudsman at BC. She told me that they had to void the auth for Dr. M so that they could review Dr. S's auth and that it could take 2 more days. And that if it was denied I could appeal again. I was so upset....I have fought for over a year. I did not want to start over with appeals.
About 20 minutes after I hung up with the ombudsman she called me back to tell me that she had just spoken with medical management review department and they had made their decision. She asked me if I was sitting down. So then I was scared shitless. She said that my request was APPROVED!!! For reals!!! APPROVED for Dr. Simper!!!! I was crying so hard I had to put the phone down. It felt like such a huge weight was lifted off my shoulders.
I immediately called Dr. Simper's office and gave them the approval number. I should be getting a call at the end of next week with a date for surgery.
It's been a long, hard, road. But I think I can finally see the light at the end of the tunnel. Thank you all so much for your support and putting up with me.
So yesterday I got a call from the ombudsman at Blue Cross. They wanted a letter or an email stating why I wanted/needed to go out of state to have the surgery. They requested the email within 2 hours. I know there are no surgeons in Idaho that do the duodenal switch. The only one that did do it retired two years ago and he was an ass, but I called both hospitals in Boise and got the names of the bariatric surgeons practicing at their hospitals and then called their offices to verify that they don't do it and put their names, phone numbers, and hospitals in the letter. One doctor said he might start doing it in 3 years. Pfft. AND in the letter I had to write that I wanted the authorization with Dr. M VOIDED so that they could process the request for a new surgeon. However....I was assured that the authorization wouldn't be voided until they could make an approval on the new surgeon's request. Voiding that authorization scared me to death!
This morning I checked the BC website and Dr. M's auth said VOID and Dr. S's auth said Pend. I was freaking out! I called the ombudsman at BC. She told me that they had to void the auth for Dr. M so that they could review Dr. S's auth and that it could take 2 more days. And that if it was denied I could appeal again. I was so upset....I have fought for over a year. I did not want to start over with appeals.
About 20 minutes after I hung up with the ombudsman she called me back to tell me that she had just spoken with medical management review department and they had made their decision. She asked me if I was sitting down. So then I was scared shitless. She said that my request was APPROVED!!! For reals!!! APPROVED for Dr. Simper!!!! I was crying so hard I had to put the phone down. It felt like such a huge weight was lifted off my shoulders.
I immediately called Dr. Simper's office and gave them the approval number. I should be getting a call at the end of next week with a date for surgery.
It's been a long, hard, road. But I think I can finally see the light at the end of the tunnel. Thank you all so much for your support and putting up with me.
