triciaknox

Okay, thanks for all the good advice about calling my insurance company. However, now that I have some answers, I am confused and upset.

I have thought over WLS for over a year, finally deciding last December to go for it. I called Sharps and they told me to go to a meeting up in Oceanside. I went (with my buddy), got the info, filled it out the next day, got the tests done....then went into waiting mode. Finally found out almost 2 months later that this doctor wasn't "in" my area and the insurance wouldn't approve him. GRRRRR. So, back to my doctor I go and I get referred to Dr Callery. Two month wait just to get to an orientation, which my buddy couldn't attend cause of work reasons. Got the info, filled out the packet, got the final test done two months later (long wait for a mamogram). Almost 3 weeks later the mamo results get to Dr Callery's office. My file goes into dictation. On August 10th (remember this date) my letter is faxed to HealthNet. On September 1st the company I work for changes to Pacificare. On September 11th I finally get my health insurance cards and on the 13th fax a photocopy to the office and they refax my letter over to Pacificare. I call the insurance company on the 14th, they have no request, so I have Rose at Dr Callery's office refax it. Today I called them again. Still they say they have no request on file. So, I asked them just how backlogged were they? The guy got all snooty with me and tried to tell me that my primary physician was the one to approve the surgery. Yeah right. Insurance questions the decisions a doctor (who has gobs of med school knowledge) and doesn't want to pay, but now they are gonna let a doctor tell them what they will and won't cover? Was I born yesterday? Do I have a "stupid" sign on me? Well, I called my primary, got her head nurse. What she said floored me. My surgery was approved on August the 4th! Yeah, something makes no sense here since the letter wasn't faxed over according to my patient record till the 10th. But regardless, Healthnet approved it. Does me little good now, Pacificare is now my insurance. Apparently though Healthnet never told anyone that it was approved. So I feel frustrated and let down here. One good thing I guess. If Pacificare denies the surgery I have the knowledge that HealthNet approved it to use on them.

Okay, venting done. I am gonna go do some quilting and watch a DVD. If I quilt I can't eat. No crumbs or food stains allowed on Art-In-Progress. I don't make the rules, I just abide by them!

Tricia In Escondido