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codequery

Vent

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Vent... having a difficult time getting bariatric doc office to submit to insurance. I did a 6 month nutritional program through my former insurance, gave release to doc office (still haven't requested it). I also did 10 months of Weight watchers from august 2016 - may 2017 and even had doctor visits in august, October, April, (and several others) where my weight was recorded and even nutrition discussed - though the visits were not specifically for that. I have talked to my current insurance several times and they are very much encouraging me to have my doc office submit for approval. Especially now since my medical tests revealed a hiatal hernia and gerd (i knew I had gerd) and that sometimes a waiver is given. However, the person at my doc office is being a bit snippy about turning it in for approval because she thinks the people I talked to at my insurance are wrong. I am trying to get them to submit but agh. (they also still have to request my ekg results since hospital was not theirs and get the online bariatric psych eval place to actually send my approval results). A bit frustrated.

 

Just in case I started the 6 month nutrition visits through my doc back on the 6th

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5 minutes ago, codequery said:

Vent... having a difficult time getting bariatric doc office to submit to insurance. I did a 6 month nutritional program through my former insurance, gave release to doc office (still haven't requested it). I also did 10 months of Weight watchers from august 2016 - may 2017 and even had doctor visits in august, October, April, (and several others) where my weight was recorded and even nutrition discussed - though the visits were not specifically for that. I have talked to my current insurance several times and they are very much encouraging me to have my doc office submit for approval. Especially now since my medical tests revealed a hiatal hernia and gerd (i knew I had gerd) and that sometimes a waiver is given. However, the person at my doc office is being a bit snippy about turning it in for approval because she thinks the people I talked to at my insurance are wrong. I am trying to get them to submit but agh. (they also still have to request my ekg results since hospital was not theirs and get the online bariatric psych eval place to actually send my approval results). A bit frustrated.

 

Just in case I started the 6 month nutrition visits through my doc back on the 6th

I'd be frustrated too. There are often a lot of people involved in the chain of approval and it just takes one to throw up a blockade, even when not justified. Don't be reluctant to write a level headed, pleasant letter to your doc - which he or she will indeed read - thanking him or her, and detailing how your insurance is asking them to submit this, and how excited you are about the surgery and its potential benefits....

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I'm sorry to hear that. Burgundy Boy's letter idea is a good one. Or, call back another day and talk to her again. If she was snippy it may not have had anything to do with you. She could have just been having a bad day. But, if she gets snippy again, I would say, "The insurance company says submit now and you say no. I need surgery and I'm stuck until you submit for approval. I don't know what to do." (and then cry, or sob. If it were me, I'd sob.) 

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See if you can get the EKG and psych results sent yourself to move things along. If they have everything in their possession, it's harder for them to say they won't submit it. Sorry the process is frustrating.

Edited by Gretta

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I contacted the place where my EKG was and the psych eval place, the hospital that did the EKG says the medical office has to ask for it.  The psych eval place I am waiting to hear back back.  I contacted them asking them to send over the results again.  

I sent an email this morning to the two people I am dealing with at the doctors office and we will see how that goes.  If not well, I might see about contacting the doctor.  

 

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16 minutes ago, codequery said:

I contacted the place where my EKG was and the psych eval place, the hospital that did the EKG says the medical office has to ask for it.  The psych eval place I am waiting to hear back back.  I contacted them asking them to send over the results again.  

I sent an email this morning to the two people I am dealing with at the doctors office and we will see how that goes.  If not well, I might see about contacting the doctor.  

 

They are in the business of surgery. I expect if you sent the email to two people, they will submit.

 

 

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That's frustrating. So, the doctor's office is saying the insurance company is wrong in what they are asking you to have them submit for approval? I'm sorry, the insurance company should know what they want. Sounds like your doctor's office staff is dropping the ball. The letter is a good idea, I hope sending it to two people get the process expedited. Is there another possible bariatric center you can use nearby that you can tell your existing doctor's office that you'd be more than happy to transfer your files to if they can't get their stuff together?
 

I'd lose my mind. That's frustrating.

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I agree with Zen_Steph above. And even if you (and the insurance company) ARE wrong about something, at least you'll be denied, provided a reason why, and can then fix the issue.

Like Stephtay said, they in the surgery business. Get a hold of as many people as you can and just really ring some bells.

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@codequeryOne advantage of a letter is that it is documentary evidence of a conversation, request, or similar interaction. A phone call isn't the same level and may not be documented at all...

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I have done most of my communication via email (I like a written trail) and there have been two staff involved.  One didn't have a problem with it, but isn't the one that submits to insurance.  The one with the problem is the one that does that portion.  I sent an email on friday and I expect Ill hear back on Monday or Tuesday.  Depending on how that goes, will depend on what I do next.  I have put in for a consult at another place, waiting on a phone call.  So if all else fails, i'll go elsewhere.  Though i am hoping I can get this resolved here, I otherwise have liked this place.

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