I'm So Frustrated I could Just................... - ThinnerTimes

triciaknox · 09-17-2004, 08:06 PM

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

johnedezz · 09-17-2004, 08:19 PM

It took me over nine months to get surgery through Sharp. I started out with a very polished presentation from a doctor at Sharp headquarters...filled out the paperwork for this doctor only to get a letter from Sharp that the doctor was not in their network. Dr. Callery has a contract with Sharp for Bariatric surgery. The process is long and tedious. The first approval letter I received was from Sharp approving my attendance for the orientation meeting. Your PCP needs to recommend the surgery and Dr. Callery does the justification for the surgery to the insurance. The road is long but it will be worth it. Hang in there and don't give up....the insurance company tries to wheen off the folks that don't want to be persistent. Don't give in to them. Be very careful with insurance changes, consult Dr, Callery's office so you don't need to duplicate tests you already had previously.

I had surgery this last Monday and am doing fine. Once you get to insurance approval it goes very fast.....hang in there my friend.

triciaknox · 09-17-2004, 08:30 PM

Thanks. I intend to call Pacificare back on Monday.....and talk to a supervisor. I have also decided to put this in God's hands. If He means for me to have this surgery, then it will happen.

Tricia

Blueyz · 09-17-2004, 09:43 PM

Tricia,
Hang in there. You are almost there. Just keep fighting and it will pay off. Soon, you will be with the losers. It happens pretty quick once they approve. Good luck.

Christina · 09-18-2004, 09:51 PM

Tricia,

You'll do fine. One day at a time my friend. It WILL happen for you.. I just know it. You've already been approved by healthnet so you have some ammo for Pacificare. Don't worry about it. Oh and hey if you ever want to get together and quilt I have some projects I've been working on and maybe this would help me get them done..

I love quilting!!! Well, I am still a beginner only completing one so far but have two others that I'm working on.. let me know girlfriend.. I live not too far from you..