Denied again!!!! - Page 4 - ThinnerTimes

Native2u · 06-13-2008, 07:26 AM

Quote:

Originally Posted by Godsblessedme

see! i told you you'd get results with the reviewer RN ! wooohoo well i would personally talk to the pcp not just leaving a message since the nurse there has much "tude" and i would mention that to him too. usually they are just MA's and have no actual nursing experience other than blood press's, injections and such. So i would speak to your doctor. And hoping that the WL insurance person will REDO her work to state your wanting the appeal. it sounds like your making headway

I went to see my PCP last Tuesday and told him line-by-line what my insurance company needs to see. I offered to help him and his staff, if they were busy (and they are). He told me that he was going to re-do all of this....and let ME write the denial letter (considering I talked to the supervisor of aetna and she told me what to put in the letter~round & about). I'm willing to write the letter....that's fine with me! I asked him if he could please have this done by Monday, so that I could pick it up...cause then I have a letter to write. I also told him that I want to send the "appeal" packet out by Thursday, next week. He told me that should be a problem.

My PCP also had me talk to his assistant and she is such a a** to me. As I'm asking (not telling) her to please give me a copy of the "handwritten" bills that they write on when you visit......she is just typing away on her computer. I thought that she was looking up MY information, but NO.....I looked at the screen and she was doing something else with another patients records. WTF!! I was so upset! Finally, I said......Dr. Earle said to give me a copy of the records so that I can write the denial letter, while you guys fix my typed records. She looked up and I was there & so was my doctor. Ha to her, I thought!! After he left, she refused....YES, REFUSED....to give me the copy of my records (she had reprinted what I didn't need ~ cause I already have them) for the doctor. I asked her to copy the ones with "his" handwriting on them and she still refused (saying too much ink will be used with the copier)! Its MY right to have MY records!! I just left, she started doing other things and acting like I wasn't there.

So, I emailed her yesterday and told her that I need to pickup my records on Monday. If I don't hear from her my 11am.....I sending another email (my documentation) and calling her as well.

Yes, I did tell the doctor about the sh*ty attitude that she has, and he told me that she is under a lot of stress dealing with insurance companies. I told him that she has been treating me like this for a while....not just day or yesterday. I have been a patient of his for 8-9 yrs. After all of this is said and done.......I hate to say this but, I'm looking for a different doctor (PCP). I hate being talked to like I have no idea what's going on.

Native2u · 06-13-2008, 07:30 AM

Quote:

Originally Posted by BuCwiLd

this thread really worries me please review this and tell me what you think...

here is what the surgeon wants.

1. stop smoking 2 months prior to date
2. 5 percent weight loss (they wanted 10 but my disc problem doesnt allow me to exercise)
3. read a book / 10 modules
4.attend 3 educational classes
5.attend 2 support classes
6.metabolism determination (whats that?)
7.psych evaluation
8.rd evaluation with green light (dietitian)

here is what my insurance requires

1.obesity present for more than 5 years, medical documentation needed.
Now it has existed for way more than 5 years but i moved from Ct to pa 3 years ago. I have med doc. from 06 foward but i hadnt seen the doc prior to that since 2003. so i only have 3 years.i called my previous doc and he said he would search for it but honestly they may be gone due to it being more than 5 years ago

2. bmi of more than 39
check- mines is 43

3.history of failed dieting
I dont have that (guess the 6 month program will cover that)

4.current medical evalution
check-i can do that

5-document of a co-morbid medical condition
check-high blood pressure, somewhat high cholesterol .

I do have 3 letters from 3 different surgeons stating that this surgery is nessasary in order to have my back fused or discs replaced..I am currently out of work for more than a year.. Everything in life is pretty much impossible

I think that you will fine too. For your #3, have you even placed yourself on a diet? If you have tried different diets & OTC meds to help loose the weight.....write a letter from you to your insurance company, with a self-history. I included a letter to my insurance company...I think that a lot of people do.

Godsblessedme · 06-13-2008, 08:55 AM

hey is that crappy lady overweight? The reason i ask is because i faced this situation with my referrals coordinator and she was so nasty to me (until someone else started the referrals) i had to pull teeth to get her to do somethin i asked and she always had a smart remark for me.

Hang on in there it'll come just dont give up doing all the advocating for yourself. I dont kknow why some refuse to do their job, arent they getting paid!

Native2u · 06-13-2008, 01:41 PM

Quote:

Originally Posted by Godsblessedme

hey is that crappy lady overweight? The reason i ask is because i faced this situation with my referrals coordinator and she was so nasty to me (until someone else started the referrals) i had to pull teeth to get her to do somethin i asked and she always had a smart remark for me.

Hang on in there it'll come just dont give up doing all the advocating for yourself. I dont kknow why some refuse to do their job, arent they getting paid!

She isn't overweight at all. I don't know what her problem is, but one day, I'm gonna snap at her. I have had enough out of her. I'm going to have MY say...probably when I'm leaving the practice (after surgery).

My Mom always told me...."the best way to get back at someone is to kill them with kindness" and that is very true...it has always worked for me, until I met this person. I truly feel sorry for her hubby, if she is that way all the time.

Vikkator · 06-13-2008, 01:57 PM

Val, do you really think she's got a husband? I doubt it.

Native2u · 06-13-2008, 05:19 PM

Quote:

Originally Posted by Vikkator

Val, do you really think she's got a husband? I doubt it.

Ok...true that! She probably ran him off with her foul attitude. I know she has a kid though...like 2-3 yrs old.

Native2u · 06-19-2008, 12:26 PM

OK.....sent her an email, last week Thursday (6/12). On Tuesday (6/17), I still didn't receive an email or phone call from her. So, on Wednesday (6/18) I called her at 1:30pm and left a message (they wouldn't let me talk to her). At 3pm I called again and left another message this time with the message I said....."I have emailed her twice and called once today, can you please have her return my call and tell me something"?

Well, well, well.....at 3:18pm I get an email that says this.

I spoke to Dr. Earle and he just said I'm working on it. I'll speak to
him again but please know I can't make him hurry I can only relay the
messages. I do my best and let you know. Also I do not check e-mail
everyday

Does this sound like crap to you? It does to me! Who doesn't (in the medical field) check their emails?

ericajones80@yahoo.com · 06-20-2008, 07:23 AM

insurance companies and the devil share the same address...that is one thing im sure of

snick1899 · 06-20-2008, 08:00 AM

Quote:

Originally Posted by Native2u

OK.....sent her an email, last week Thursday (6/12). On Tuesday (6/17), I still didn't receive an email or phone call from her. So, on Wednesday (6/18) I called her at 1:30pm and left a message (they wouldn't let me talk to her). At 3pm I called again and left another message this time with the message I said....."I have emailed her twice and called once today, can you please have her return my call and tell me something"?

Well, well, well.....at 3:18pm I get an email that says this.

I spoke to Dr. Earle and he just said I'm working on it. I'll speak to
him again but please know I can't make him hurry I can only relay the
messages. I do my best and let you know. Also I do not check e-mail
everyday

Does this sound like crap to you? It does to me! Who doesn't (in the medical field) check their emails?

I am sorry this has been such a pain for you. trust me, I know what you are going through. When I was trying to get everything ready for my insurance company, it took me 2 months to get in touch with the girl at my doctor's office! She only works on Fridays...sometimes. She didn't always come in. When I finally got in touch with her she was like "Oh, let me transfer you, I'm not the person you need to talk to." I was FURIOUS! It was a lot of tears and emotions (I sat on my floor and cried every friday when I called and she wasn't there) but it finally worked out. I believe it will for you too. Just hang in there and keep your head up!

Native2u · 06-20-2008, 09:50 AM

I only have 60 to appeal. So, that means that..... I only have until July 9th to have everything tuned in to my insurance company. If I don't get my appeal turned in by July 9th.....I have to start completely over from the beginning.

I have already been on the phone with my doctors office this morning....they just took a message.