Hi everybody!
I've been pursuing top surgery since late in June of this year. I have an HMO so I needed to get a referral from my GP. 10 days after my appointment I received a letter that the approval wouldn't be made by the medical group but by the insurance carrier. It's a contractual thing. I called the insurance to get details and a timeline. That is where the frustration began!
Calls to the insurance by me, calls to the medical group by me. Insurance called medical group, medical group called the insurance. Ugh. It was back and forth, "We sent the info", "We don't have anything on record", "We sent the info", ... you get the idea. Interestingly, once I got the approval letter it referenced getting the referral request on a date 2 weeks prior to my hearing, "We don't have anything" yet again.
Referral in hand I make an appointment with the surgeons office. Of course he's on vacation so I get one on 9/14. Two week wait, not so bad. Still a good chance to have surgery before year end. I get a return call from the scheduler about 15 minutes after hanging up. She can't find the referral in the medical groups internal system. I give her all the numbers I can find on my letter. Nope, that referral is closed. More calls to the medical group, the insurance, the surgeons office. Even took a drive over to deliver copies of the 2 letters I now have in hand that approve me for a consultation. She'll make another call. If it's not in the system they can't bill for the services. It won't be in the system since the insurance approved it instead of the medical group. They take my insurance just figure it out!
I'm operating under no news is good news and head over to the appointment last Friday. I walk in and she starts gesticulating and telling me they can't see me. Didn't I get the long message she left for me, NO! I leave anguished but trying not to feel defeated.
Back on the phone with the insurance. Rep can't understand why I was turned away. Offers to call the office, comes back on the line and is just as confused as I am about why they can't make this work. Talks to her supervisor. Nobody can understand it, including the referral case manager at the medical group. Now I have to get another referral, rep sent a request to the medical group for an expedited referral to another surgeon (48-72 hour turnaround).
Going call the medical group tomorrow to follow up on that referral. 3 months for a referral just for a consultation, scared to think how long approval for surgery is going to take.
Perry
