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
I am so sorry you have to deal with that. It is absolutely crazy-making. This is one of my biggest fears with surgery, that flavor of stress sends me right over the edge.
Good luck and I hope it gets sorted soon.
Sorry, the waiting is awful Perry. It just plain stinks. It made me what I am today though, 'bat poop crazy.'
Sounds like a lot of buck passing, Perry.
If they cant get it right, get a name from each place and if you have to, get them on the phone with you at the same time.
Quote from: HappyMoni on September 21, 2018, 09:02:11 PM
Sorry, the waiting is awful Perry. It just plain stinks. It made me what I am today though, 'bat poop crazy.'
So what is it about bat s*** that makes it crazier than other s***?
Sent from my SM-G930T using Tapatalk
It's taken me a little over two years to be comfortable with myself. Yes it does get frustrating. But it applies to everything. One thing this process does is teach patience. And as to Moni she is Bat poop Crazy. But we love her anyway. :icon_peace:
Tonya... You're not as likely to step in it unless you explore caves.
Ah, Siri what makes bat poop so special?
Perry please be sure to update us, okay?
Moni
Oh gosh I just asked Siri. There is something really funny about asking Siri to say "bat poop." I am such an idiot!!! (Hoping that made you agree and maybe smile, Perry.)
UPDATE
Finally received my new referral in the mail yesterday!
Monday morning I will be calling for a consultation appointment. I'm trying to be optimistic that I can get surgery before the end of the year.
Perry
@HappyMoni you made me smile!
Quote from: Perry on October 06, 2018, 09:14:33 AM
UPDATE
Finally received my new referral in the mail yesterday!
Monday morning I will be calling for a consultation appointment. I'm trying to be optimistic that I can get surgery before the end of the year.
Perry
@HappyMoni
you made me smile!
@Perry Dear Perry:This is terrific news... I trust that you can get a consultation appointment as soon as possible... the end of the year is coming fast so the faster that you can procure appointments for the consultation and for the pursuant surgery, the better.
We will all be rooting for you... as you feel so led, please keep us all tuned in to your future developments regarding this.
Wishing you well, we will be trusting for your good reports.
Danielle
BIG YEA, for Perry! Glad to hear your news!
I called the surgeon's office and had to leave a message. No return call that day or the next. I called again on day 3 and left yet another message. Received a call back about 40 minutes later. (This isn't a positive first impression!)
We scheduled my consultation for 2 weeks out, the 24th. Not a bad wait. Had a return call about an hour later, could I scan over the referral? Even though the doctor is .cc'd evidently they don't have it. Sure, first thing in the morning. Arrived at work and scanned the referral over. Then I received an email, can I scan over my insurance card front & back? No problem, sent it on its way.
I haven't heard back since, I'm taking that as a good sign. Perhaps they have managed to figure out how to get paid for the consultation, something the previous referral doc couldn't.
So, I have my consultation coming up on Wednesday. I'm getting excited, I have all my questions written out. Now I hope I like this guy or I'll have to change my insurance to a PPO and wait until January to start over. Good timing, open enrollment starts on Monday.
Perry