Question:
How long should I wait for the Doctor's office to send info to Insurance
I saw my Surgeon Dr. Spehar on April 28th for my first consultation. He wasn't real talkative and was ready to leave the room before I had really even asked any questions. He said all we had to do was send in a letter of pre-determination to Prudential and then schedule the surgery. They said they both faxed and mailed a letter on May 1st to the insurance company. Prudential said they've never received it. Then I get a call from the Doctors office saying they now need all my past Medical documentation of any co-morbidities that other doctors have seen me for. They said the "ball is in my court now". Should I be concerned or is this normal? Sorry for going on and on. Just really want to get things going. — Shelli M. (posted on May 5, 2000)
May 5, 2000
Shelli, all I can tell you is my experience. My surgeon's office sent me
forms to fill out listing all my health problems and all my dieting
attempts BEFORE I actually saw him. That way he had all the information
when I had my consultation. And I don't understand how they could submit
for approval without that information. I personally don't like the tone
they seem to have taken with you. (Just my personal opinion).
— Nancy G. W.
May 5, 2000
Shelli, I too had a bad experience with a surgeon. His office is 45 minutes
away from home.
My first consult with him lasted every bit of 3 minutes. He
said,"So you want to get skinny huh?" I told him I wanted to get
healthy. He handed me a book and told me to go home and read
it and if I still wanted to do it, call back and make an
appt. That's what I did. The day of my appt. he had an emergency
and was running very late. I waited patiently. When I went
back to the room, I could hear him in the next room chewing
out a patient. I started getting really uncomfortable. I had
some questions for him when he came in. He spat out a few
answers and made me feel like he didn't have time for me. I
didn't ask all of my questions. His office staff scheduled me
for surgery and called the insurance company for pre-certification.
They denied me immediately. I had to pay $300. I didn't appeal
the denial. Instead I found this web-site and educated myself
on the different surgery options and found another surgeon.
I called and made an appt. I was sent papers to fill out
about my medical history. When I met with him I knew he was
the one I wanted to do my surgery. I never felt the least
bit uncomfortable. This wonderful doctor is 3 hours away. It's
worth it to have peace of mind. Don't settle for just anyone.
Make sure you are comfortable with your surgeon. After all,
he is going to hold your life in his hands.
— Tina H.
May 5, 2000
I too had a form that had medical as well as diet history questions on it.
After the clinic received that form the nurse who writes their medical
necessity letters called me and I had a phone interview with her. She then
wrote the letter within the week and sent it in to the insurance company.
I was one of the lucky ones and got my approval the very next week. It
seems the clinic you went to got things a bit backwards. Find a clinic you
feel comfortable working with. This really is a team effort.
— Jilda H.
May 5, 2000
In general, a good thing to do is to fill out all your forms, have the
surgeon and other docs fill out theirs, go to their offices, pick up the
forms, make copies, and send them yourself through the Postal Service
special delivery, "return receipt requested" to the insurance
company. You will know the papers arrived, and you will know who received
them. If the insurance company denies receiving them, you can tell them
that the feds will have to investigate. It gets things done!
— Heddy-Dale M.
Click Here to Return