Denied again!!!! - Page 5 - ThinnerTimes

Native2u · 06-20-2008, 02:09 PM

Quote:

Originally Posted by snick1899

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!

I noticed that you have your date for surgery!

Congratulations!!

NOW....I want mine!

Withacy · 06-23-2008, 11:19 AM

Nothing strikes fear into the hearts of the medical community like those five simple letters - HIPAA. It stands for Health Insurance Portability and Accountability Act. Most people know it means that your medical records have to be protected (only those who "need to know" and are HIPAA compliant, are allowed to know). Some know it has something to do with pre-existing condition exclusions.

What a lot of people don't know is that it also gives you the right to your records and all personal information kept about you. It belongs to YOU.

So use those letters. Let them be your friends. And see if it helps.

snick1899 · 06-23-2008, 11:23 AM

Quote:

Originally Posted by Native2u

I noticed that you have your date for surgery!

Congratulations!!

NOW....I want mine!

Aw, I am sure you will get one soon!
I have tremendous faith!!

Native2u · 06-23-2008, 07:28 PM

Quote:

Originally Posted by Withacy

Nothing strikes fear into the hearts of the medical community like those five simple letters - HIPAA. It stands for Health Insurance Portability and Accountability Act. Most people know it means that your medical records have to be protected (only those who "need to know" and are HIPAA compliant, are allowed to know). Some know it has something to do with pre-existing condition exclusions.

What a lot of people don't know is that it also gives you the right to your records and all personal information kept about you. It belongs to YOU.

So use those letters. Let them be your friends. And see if it helps.

I did just that today and she still will not give me my medical records. I also told her that I'm contacting legal help. I'm done with this doctor and his staff! They are the worst!! My ex-doctors assistant (nasty woman) wouldn't give me copies of the paperwork that they fill out when & while they are recording your weight/height/BMI/Blood Pressure/Diet history/Excerise/Diet, etc. She actually told me that once she types all of that information into the computer (which isn't all of what she has on that piece of paper), she throws it away!!!! WTH?? Isn't this illegal?

However, I did get the copies of the records back that I wrote all over. Due to his notes being totally informative about what really happened in the room and what we really talked about. Where I made the corrections (remember arrows are going everywhere on the paper) he just signed his initials. He said that its against the law to go back and add more information that is already in his chart, that he left out, when they typed it in the beginning. I think that they just don't want to do it.

I'm going to call Aetna in the morning and hopefully be able to do the 3 month plan or see if I can do something to make this work.

Withacy · 06-24-2008, 05:34 AM

Quote:

Originally Posted by Native2u

She actually told me that once she types all of that information into the computer (which isn't all of what she has on that piece of paper), she throws it away!!!! WTH?? Isn't this illegal?

It's not illegal, per se, to throw away hand written records in favor of computer records - but their method of disposal sure as heck better be HIPAA compliant (you can't just throw them in the trash).

From all my years working in insurance, I'd say the most important thing you can do is find a sympathetic ear at your insurance company. Every time you call you're going to talk to a live human being, none of whom have a financial stake in seeing that the company denies your claims. (I was that person for many years.) Don't be afraid to shop around (so to speak). When you call, if the person seems rushed or in a bad mood, make it simple and quick, get off the phone and try again later. Make note of who you speak with. Speak to them like another overworked person who's probably been yelled at 10 times already today. Be friendly and sympathetic to that person - even if you don't feel that way. And when you find a person who seems to know what they're doing, and who's sympathetic, write down their name (and extension, if they have one) and stick to them like glue.

In some ways, their hands are tied. But in other ways, if they want to help you, there's a LOT they can do. It can be as simple as telling you how to word things so it will be approved (I did this many times when I wanted to help someone - but never for someone who yelled at me).

And another thing they can do (and I did many times) - they can probably help you with this problem with your doctor's office staff. Hey, it's possible that these people you're dealing with won't budge for anyone. But if anyone can move them, it's the person who pays them.

And I'm also starting to suspect that they don't HAVE all the records you're requesting, and they're trying to cover their butts.

HIPAA wasn't just about privacy - it was also about instituting a new coding system, and requiring providers to submit claims electronically (to Medicare and Medicaid if they want to be paid). That's the part my agency oversees. As a result, there were a number of entities (doctors offices, hospitals, data clearing houses, insurance companies - even STATES) who had "accidents", and lost massive amounts of data.

But it is possible, if the information still exists, that the insurance company (or more importantly, a kind individual at the insurance company) can get that information for you. They also might be able to get information from previous insurers, if that information still exists.

Good luck with this. If there's anything I can do to help, let me know.

Native2u · 06-24-2008, 08:35 AM

Quote:

Originally Posted by Withacy

It's not illegal, per se, to throw away hand written records in favor of computer records - but their method of disposal sure as heck better be HIPAA compliant (you can't just throw them in the trash).

Good luck with this. If there's anything I can do to help, let me know.

Every time that I went to see this doctor (6 months), his assistant would weigh me, get my height, PB, write down my BMI, & more and then the doctor would make his notes on that same piece of paper.

The records that are now typed, that she gave me a copy of......most all of the information that I stated above it missing. That is why I have asked for copies of all of those papers....cause I know its there, on that paper. I need that information in order to file an appeal & also for my lawyer. I only have until July 9th to get the appeal to the insurance company. I don't have a lot of time here.

I talked to my hubby last night and he gave me the "green" light on hiring an attorney for the appeal. Now I need to call my insurance company and ask a couple of questions.

Thanks for your help.

Godsblessedme · 06-24-2008, 06:08 PM

let me ask this, how much money would you pay for an attorney? have you ever gotten a cash pay estimate from your doc? i still say fight that appeal by the 9th but can you take out a medical loan?

Native2u · 06-24-2008, 06:53 PM

Quote:

Originally Posted by Godsblessedme

let me ask this, how much money would you pay for an attorney? have you ever gotten a cash pay estimate from your doc? i still say fight that appeal by the 9th but can you take out a medical loan?

I have actually thought about that.....medical loan. But, who does that?

I would have to pay $450-$850 for an attorney. Depending on how much help I will need/want.

I also called Aetna today and I was reading the dates wrong....I have 180 days from the date the letter was written for denial to file for an appeal. The letter was written on May 9, 2008. So, I have more time on my hands. Thank the Lord!!

Native2u · 06-25-2008, 06:20 AM

I'm going to see a different doctor in the morning. He is an Internal Medicine doctor. He is the one that changed all of my HB meds around so I didn't have any side effects. My other doctor was giving me meds after meds to cover side effects, and I got upset and found another doctor. I'm hoping that the new guy will help me out with starting over. I hate to do it, but after talking to Aetna yesterday, I was hoping that Aetna had a 3 month program and they don't. So, I'm stuck. Although, I have been to see him for over 3 months straight, we didn't talk about WLS. I know that I told him that I was going for it, but a different doctor was helping me. I just didn't know that this other doctor was going to waste 9 months of my life! (crazy thing is, the old doctor as been my doctor since 2000....you would think that he would want to help me)

Anyway, I'm hoping that the new doctor will help me out. I talked to someone in his office yesterday, when I made an appt for tomorrow and she stated that he wasn't taking anymore patients PCP wise. But, she told me to talk to him that maybe he would change his mind....to help me.

I'm truly crossing my fingers here. If he doesn't work out, I'm going to go to my parents doctor. I have heard nothing but good about him and he knows my parents history.

Native2u · 06-26-2008, 12:55 PM

Update......

The doctor that I went to see this morning told me that he could help me. He was very nice about it.

However......

I went to a second choice doctor in my area and made an appointment with him. My parents go to him and he has all of their history, etc. What better person. Oh and he also supports and has sent several of his patients to have Bariatric Surgery done, so he is very familiar with the "what to do's" part of it. My appointment is on Tuesday, July 1st. I only have to do a 3 month with him.