surgery Nov 7th---may be cancelled

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Harley44
Harley44 Member Posts: 5,446
edited June 2014 in Breast Reconstruction
surgery Nov 7th---may be cancelled
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  • Harley44
    Harley44 Member Posts: 5,446
    edited November 2007

    Hi everyone,

    Has anyone had trouble with their ps office NOT filing the correct paperwork thru your insurance company, to get the prior authorization that is needed before you can have surgery??

    It looks as if I will have to cancel this surgery, because they won't submit the paperwork to my pcm, or my insurance company.  My dh says I should reschedule, but I figure WHAT IS THE POINT?  Because if my ps office doesn't know how to do the insurance paperwork, this is only going to happen AGAIN, days before my surgery I will learn that they DID NOT DO THEIR JOB!!!  I am SO ANGRY!

    Harley

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  • LisaSDCA
    LisaSDCA Member Posts: 2,230
    edited November 2007

    What a disappointment Harley! I can understand why you are frustrated. Most PS offices have a specific employee who handles insurance pre-authorizations and slow-to-pay ins. co. claims and that sort of problem. Could you call and ask the office manager who this person is and find out why her responsibilites are slipping? Maybe she's been on vacation for two weeks (yes, they should have had someone covering) or her three kids had chicken pox. Nonethless, the Office Mgr. or suprvisor needs to know, or soon this plastic surgeon is going to find he has a lot of empty time in his schedule. That will affect the paychecks of his office staff - not to mention neglected patients like you who need their surgery dates to be honored!

    If he is an in-network MD for your insurance, I might also consider calling the member services dept. of your insurer and letting them know of your difficulties.

    Good luck

    Lisa

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  • bbmom
    bbmom Member Posts: 391
    edited November 2007

    Harley, I'm really sorry you're having this problem. Usually it's the insurance that screws up. You still have a few days until the 7th, maybe you should hold out and see if you can get things straight by then. Since the doctor's office let the ball drop they should be willing to hold your scheduled date for you to the last minute. Call your doctor, he/she needs to know how their office is being run.

    Good Luck!

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  • Harley44
    Harley44 Member Posts: 5,446
    edited November 2007

    Hi... I am not sure WHO messed up, because now I am being told that my case manager for my insurance company put through an authorization, but it may have been incorrect.  I am waiting for a call back from a TRICARE rep from Fort Bragg to let me know if the approval is in the system.  This morning, we drove all the way to Ft. Bragg, to get new I D cards, because my dh has retired, and we now need to show our retired status... 

    I am having trouble with my new case manager.  Whenever I call her with a question, or a problem, she tells me it is MY RESPONSIBILITY to do these things... but how am I SUPPOSED to get authorizations for surgery and office visits??  I am JUST A PATIENT, and I don't believe that we should have to jump thru hoops for these stupid insurance companies, when they don't pay a nickel, if they can get out of it! 


    Sorry for venting!  I am just SO MAD!  how am I going to keep dealing with these idiots?

    Thanks

    Harley

    I have decided to wait and see what happens next.  My dh asked me what am I going to do if we find out that my case manager is the one who screwed this up?  If I call her back and explain to her that it is HER FAULT, we will just end up in a verbal fistfight.

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  • AnnieBird55
    AnnieBird55 Member Posts: 122
    edited November 2007

    Hi Harley ,

    Almost the same thing happenned to me for my bilat mast! I was very angry too! I had a ton of anger, and I was crying at the same time!

    Looking back on it, it was a matter of EVERYONE not using voicemail. The insurance co would leave a voicemail with the breast surgeon to call them (but no 'meat' in the voice mail). Of course, the nurse who had the voicemail was on vacation. Some other nurse called the hospital asking for a surgery date. The hospital called that nurse back and asked her to call them (but left no question).  All of the following were involved:

    - The hospital (scheduling the surgery)
    - The breast surgeon (in charge of slicing me open and the Sentinle node biop)
    - The Plastic Surgeon (in charge of Recon and making sure expanders are delivered)
    - The insurance company - giving a proper written (fax) authorization for the surgery. My Insurance company said it takes 10 days sometimes from when the suregeon makes the surgery request to when the insurance "board" meets to approve!!

    What made me SOOOO angry was that I called the insurance company during my holdup and they said the "board" approved the left breast mast/recon (it had cancer) but NOT the right one (I was going for prophyl on right).

    Well, knowing I was so upset, I asked my husband to take over and handle all the telephone calling. When I got home from work that evening, it was scheduled. {I am still angry about it and that was 6 months ago!}.

    Since your dh is retired ...dare I suggest he try this calling for you? It is hard for us ..at least I know when I was so emotional on the phone I was not getting very far.

    Since it seems your insurance company is the hold up - start there and ask for a manager if you cannot get a good explanation.

    Here is another thing that I did when my PS would not get back to me: go to the office (w/o an appt) and stay there until they answer your question or file the paperwork. I know it sound annoying ...

    ....

    I am sorry you have to deal with this.

    -Anne

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  • determinedmom
    determinedmom Member Posts: 276
    edited November 2007

    Are you Tricare standard or Prime? Whoever is doing the surgery needs to obtain the authorization. However, if you are Prime, your PS needs auth. from PCP before they can do anything. Tricare is really encouraging physicians to obtain authorization on line. In work in a PCP office and go on line all the time to obtain auth for Tricare Prime referrals, testing, etc., it's so easy. Usually get auth back w/in 24 hrs. However, since we don't do surgical procedures can't help, but can't imagine it being much more difficult.



    Definitely get on your PS to do their job and follow through w/ Tricare. It's amazing how quickly things can get done when patients really get involved. It just su**s that the patient should have to be their own advocate. As if we don't have enough to worry about.



    Best wishes,

    Jeanne

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited November 2007

    Oh Harley,

    Im so sorry to hear this !!!!! It is so frustrating for these types of things to happen...I hope it gets straightened out soon....

    Hugs

    Jule

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  • Sadie-Rose
    Sadie-Rose Member Posts: 222
    edited November 2007

    Harley,

    This is such a frustrating time.  I don't think the people in charge of giving approvals realize the anxiety surgery can bring to a patient. 

    I think we gear ourselves up psychologically for the date we are given.  Then our best defenses topple when there are changes in our plans.  Many women are planning for childcare or for family members to travel in to help them.  Their husbands or partners may have applied for vacation time to be with their loved one.  It really is a big deal when approvals are delay!

    i hope everything gets resolved for you.

    Warmly,

    Sadie

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  • Harley44
    Harley44 Member Posts: 5,446
    edited November 2007

    Anne,

    Thanks for the advice!  I will try on Monday to get the ps office to get my authorization for the hospital... this s*cks, because I thought that this hosp. WAS NETWORK, that is why I chose it!  Since I had my other surgeries there, I was pretty sure...

    Thanks

    Harley

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  • Harley44
    Harley44 Member Posts: 5,446
    edited November 2007

    Jeanne,


    I think this is outrageous!  The patient SHOULD NOT have to get involved!  I mean, they SHOULD KNOW what needs to be done... this is just SO STUPID! 

    We are TRICARE PRIME and that mean EVERY THING NEEDS AN APPROVAL! 

    MY case Manager doesn't even know the rules... she told me that because my surgery is OUT PATIENT, I won't need an authorization for the hospital, but I called the hospital and was told that YES INDEED I will need authorization...

    Thanks

    Harley

    P S   I guess I'll just get those prosthesis, since I think that requires less BULLS**T than the surgery!

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  • Harley44
    Harley44 Member Posts: 5,446
    edited November 2007


    Thanks, Jule,

    I guess I will TRY to get this worked out in time for the surgery, but I am not counting on it.  If I don't get someone to help with this early Monday Morning, I will have to cancel the surgery, because my pre op tests are at 11:00 on Monday.

    Harley

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  • Harley44
    Harley44 Member Posts: 5,446
    edited November 2007

    Sadie,


    Thanks.  I think if I can't get this resolved, I will have to just cancel and forget about it. 

    My dh said that he thinks we should just go get the prosthesis, and forget about the surgery. He is just fed up with all this crap, and so am i, but I am the one who has to call, and I am so worn out by it.


    HARLEY

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  • itslisalouwho
    itslisalouwho Member Posts: 74
    edited November 2007

    From years working at a Drs office....I would bet it is 99% your insurance companies fault. 

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  • AnneW
    AnneW Member Posts: 4,050
    edited November 2007

    TriCare is pretty strict about the authorizations. I have Standard, so I don't have to deal with a PCP trying to get the auths. I have found TriCare to be very helpful when I call, though. Go to your region's website and get the phone #. Call them, ask what's up, and what needs to be done to expedite things. Sometimes you just have to do it yourself...

    Anne

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  • determinedmom
    determinedmom Member Posts: 276
    edited November 2007

    Harley, I agree, the patient should NOT have to get involved. That's what we pay premiums for and in your case, the military service you or your spouse provide for our country. Unfrotunately, ins. companies are getting stricter and their CEO's are making more $$. It' SU**S that our doctors who know what is best for us have to go through red tape due to this SH**. However, getting involved and being an advocate for yourself does make a difference. If you have to, fight for the surgery YOU want, don't settle because of your insurance company. It's federal law that if you have breast cancer your ins. MUST pay for breast reconstruction; even has to pay for reconstruct on the good breast if nec. to look more 'uniform'. I wish you all the best and wish I could help you.



    Jeanne

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  • Harley44
    Harley44 Member Posts: 5,446
    edited November 2007

    Anne,


    Tricare has assigned me a CASE MANAGER, to help expedite all my approvals and authorizations.


    I had a case manager after my mast., and SHE WAS SO NICE!  But, she quit, and now I have a different one, and she is absolutely NO HELP!

    My case manager just told me on Friday that I don't need an authorization for my hospital, because it is OUT PATIENT... but the hospital told me that yes, I DO NEED AN AUTHORIZATION for the HOSPITAL, NO MATTER WHAT...

    So, no, Tricare is NO help...   in fact, if I just call TRICARE with questions, and if I call THREE times, I will get THREE TOTALLY DIFFERENT ANSWERS!!

    I am glad you got some help from Tricare, because I never do...


    Thanks

    Harley

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  • Harley44
    Harley44 Member Posts: 5,446
    edited November 2007

    Jeane


    Thanks.  They WILL pay for the surgery, just NOT THE HOSPITAL where I am having the surgery.  That is so stupid!  Where am I supposed to have the surgery...  in the street??

    My ps is in Wilmington and Whiteville...  I would either use the Wilmington Surg Center or Columus Regional Hospital.  I have used Columbus Regional Hospital before, but my general surgeon arranged everything, and I told Debra, his insurance person, to be sure to get the hospital approved  BOTH times!  But my ps office is run differently and I think because they do nose jobs, and usually insurance doesn't cover cosmetic surgery, they don't get involved with insurance very much...

    Harley

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  • Harley44
    Harley44 Member Posts: 5,446
    edited November 2007

    Everyone,

    Please pray for me... I am going to go on Monday for my pre op tests at the hospital, and to get registered for my surgery.  I am expecting them to tell me that I do not have authorization to use their hospital.  Then, I will ask them to call my case manager for Tricare, to get this resolved....  I am praying that they will make her work to get this authorization that I need...


    Thanks for the prayers,  They REALLY DO HELP!!

    Harley

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  • MinAZ
    MinAZ Member Posts: 368
    edited November 2007

    My thoughts and prayers are with you Harley. Hope it works out for you. I have Tricare for Life and it's been much easier. But I have friends on regular Tricare so I know what a hassle it can be.

    My exchange surgery is also Nov. 7, so we'll be doing it the same day - and we'll be so much better of on Thursday!

    Minz 

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  • Harley44
    Harley44 Member Posts: 5,446
    edited November 2007

    Thanks, Minz!

    I have my pre-op Tomorrow, Monday 11/5, so I hope they can get this straightened out with my case manager... who says I DON'T NEED an Authorization, but  it looks like I DO...

    Good Luck!!  I will be thinking about you.

    Harley

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  • geebung
    geebung Member Posts: 1,851
    edited November 2007

    Dear Harley,

    I posted a few lines to you on another thread before I read this one. So sorry you have been messed around with your surgery and am hoping it can still go ahead as scheduled.

    Good luck!

    hugs,

    gb 

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  • idobelieveinfairies
    idobelieveinfairies Member Posts: 82
    edited November 2007

    My insurance would not cover my doctors hosptial either but since it was the one he used it was covered. They cannot deny you that.

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  • Harley44
    Harley44 Member Posts: 5,446
    edited November 2007

    Hi gb,

    I was so frustrated after jumping through hoops to get all this set up, and then to find out that the hospital is not in network, I have been so upset!  I have had the other surgeries there, so I am confused.  The last time, I was pretty sure that the nurse told me that they were going to be NETWORK soon, but I guess they changed their mind...  oh, well.  I have a case manager, who doesn't want to do her job, so I will have to switch after my surgery.  My original case manager quit, and they assigned me to a new one, but she just isn't working out.


    Thanks for the good thoughts! 

    Harley

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  • Harley44
    Harley44 Member Posts: 5,446
    edited November 2007

    idobelieveinfairies,

    Thanks!  It is good to know that I will be able to use that logic if I have a problem later... I'll keep that in mind.

    I was frantic when I found out that this hospital was not in network, before my biopsy.  But, they approved it as an emergency...  but I was sure that the nurse told me that they were working to get in network, oh well.   I remember saying, I have to get this biopsy, and I can't help which hospital my dr. is connected with, THAT is the place where I am having the procedure...

    Thanks

    Harley

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited November 2007

    Hi Harley



    So has your surgery been canceled?

    Jean

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited November 2007

    Just to let you all know - Harley had her surgery yesterday.

    I spoke with her last night and she seemed happy it was finally over. I am sure we can look for a post from her soon.

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  • abbadoodles
    abbadoodles Member Posts: 2,618
    edited November 2007

    Thanks, Jean.  We are all rooting for her.

    Tina

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  • Harley44
    Harley44 Member Posts: 5,446
    edited November 2007

    Hi, everyone,


    Sorry I neglected to post.  I guess I was just sleeping, trying to get the anesthesia out of my system yesterday.


    The surgery went well.  I am doing pretty well, but man, am I sore!

    Thanks for all the support!

    Harley

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  • MinAZ
    MinAZ Member Posts: 368
    edited November 2007

    Harley - glad it's over and went well yesterday. Me too, and I was dozing the rest of the day and evening just like you. I'm doing it today also, quite a bit. I got back for post-op Tuesday. How about you?

    Minz 

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  • Harley44
    Harley44 Member Posts: 5,446
    edited November 2007

    Minz

    I think I am going back on Thurs. for Post op... but my ps isn't very concerned about seeing me.

    He is a jerk.  He called Wed. night, and asked what I thought of his work.  I told him that they look kind of small, since I wanted them to be a little bigger.  He just said... YOU WILL NEVER BE HAPPY!  He is such a jerk!

    Hope you are doing great.  I am still sore... OUCH!

    Harley

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