Up Hill Battle with Surgeons & Health Insurance - Seattle, WA

I found a surgeon in April. Their first request...

I found a surgeon in April. Their first request for authorization to my insurance was denied. The surgeons office didn't call me or write me once it was denied. It was denied for a very basic reason, they didn't say how much they were going to take off and didn't did get/send all my medical records. When I called them they said they would call me back to let if the doctor 'wanted' to appeal. They never called me back. I called around to all my doctors got the rest of the records & wrote a letter from me to my insurance company for them to send with the appeal. The denial was over turned but the surgeons office wouldn't return my calls or emails for a month. When I did talk to them they were also being wishy-washy regarding out of pocket cost.
Sooo I found a new surgeon whom I like better she said she would submit the authorization request to my insurance in a 'few days'. I advised her (per a conversation I had with my insurance co's auth dept) that there is already an approved authorization on file all they have to do is submit their own new authorization request & reference the old approved authorization so they can link up to the medical records & approval. Well that was two weeks ago.

Is it that these surgeons prefer cash patients and aren't as attentive to the patients with health insurance OR do I just have bad luck?!

How long should it take for my doctor to submit an authorization request to my insurance?

It took the doctor 3 weeks to submit the auth...

It took the doctor 3 weeks to submit the auth request to my insurance Regence. I had a nice rep at Regence helping with follow up. Once the doctor submitted the request it took my insurance 1 hour to approved the auth request!

I finally have a DATE! November 12th with a pre-op appointment November 5th. I'm so excited!
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Comments (3)

Welcome InPatient - I'm in Seattle too. I didn't know this at first but my insurance plan directly excluded BR. I never heard another peep from the first PS that I consulted with back in June! But I didn't want to use them so I didn't care. The 2nd one is the one that contacted me with the denial and then gave a private pay amount that was $3500 more than average. So I decided to shop around and the 3rd consult was reasonable private pay cost and I loved the surgeon. Its a struggle working with insurance and it takes patience. So glad you are now approved and scheduled! I am now 2 weeks PO and feeling wonderful. Love my surgeon and am very happy I did this. Wishing you the best on Nov 12th - will be thinking of you!
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That sucks your insurance won't cover BR. Did your doc try appealing the denial? I think it helped that I wrote a letter to my insurance to send with the docs appeal. It seems silly that they can exclude them if they are medically necessary. Since you're PO, do you have any advise for me? Any, "I wish I would haves"? Thank you for the good luck wishes. I'm excited for Mondays pre-op appointment :)
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Hi InPatient. It really sounds as if you are getting the run-around. Have you called your insurance company to see if they have received the records, etc from your second doctor? If they have not received them, then call the PS's office and see what they say. If you don't feel you are getting the response or consideration you deserve then I would start looking for another doc. You can search for doctors on this site, and that will help you to find out if they accept insurance. I didn't have any problem with my PS not wanting my insurance, but I'm sure that isn't the case everywhere. Good luck!
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