Wednesday, January 20, 2010

Is no news good news?

Hard to say.

At this point, my insurance company wants a peer to peer review with my surgeon. On either side, I get answers as firm as bowl of warm of cottage cheese.

From my insurance company, I get very few answers as to what it is they are not satisfied with in my pre-authorization paperwork. Seems to be a different answer every time I call. Customer service is polite, but flimsy. They seem to paint the picture, "Gee, all we want is a call from your surgeon, is that such a problem?"

Apparently, it is. It has been nearly a week and my surgeon has not called. I call both the bariatric office and his private practice (he does general surgery as well). The bariatric office keeps saying that they will call me when he can speak with the insurance company and his private practice seemed annoyed that I am asking questions like "Do you forsee an open 10 minutes on his schedule where he may call?" Remember, it is their office, not the bariatric office, that submits the paperwork to the insurance company.

At this point, I'm starting to see things from the insurance company's standpoint. Yes, a week ago they were the crapbags putting me through this and I certainly don't love their non-transparent ways. But apparently, that is the nature of the insurance business. They are the keeper of the keys and they can't be beaten, so why not play to them? If the Doc would make the call, I would at least know where I stand.

I guess that is why I am so disgusted by the federal government's new health care plan. Personally, I'm a conservative. I believe that competition drives down prices and demands higher quality in any product market. In my opinion, the biggest reason health insurance is so expensive is because only so many companies are allowed to do business in a particular state. As consumers, we can't go to another business when we are not satisfied with the services we are getting.

But, after the 2008 election, I thought "Well, we'll soon see if Canada's or England's plan can work here." Doctors, nurses and everyone in health care will be government employees. Sure, our taxes will double across the board, but the health care debate will be over. Don't get me wrong, I consider this a horrible plan and the complete opposite from allowing competition to work its magic, but at least health care would be available to all. This current plan, does neither except make it illegal to not have health insurance and does little to make it affordable. I don't know from what perspective this seems to be a good fix.

Anyway, I went ahead and started liquid shakes again. It seems so much easier. If I get miserable, I'll eat something. But at this point, it is just so much easier taking that guessing game out of the equation.

Oops, it is getting close to 9 am. I do not blog during working hours, so until next time . . .


  1. Not to start a political debate with anyone else but I agree completely. This plan that is currently floating around is convoluted and weighed down with over 1000 pages of crap. This is not the transparency I was hoping for and I agree that everyone should have health coverage but this plan is simply not the best way to go about it. As for your surgeon, I would keep pestering them. They work for you whether they like to admit it or not. If they want the cash for their services, they're gonna have to play ball with the insurance company...period. If your doc can't find the time, then I'd be finding the time to call his office every half hour until he does. Good luck!

  2. Well said Ms. Panda. Bamboo stick for you.

  3. YO Fat Bastard, your not Fat just fluffy. Keep me informed with what is going on.

  4. I keep checking back hope that you've heard something by now.

    I was going to suggest that when you call the doctor's office, ask to talk to the RN on staff. The people in the office hired to handle the insurance paperwork usually have little to no daily interaction with the surgeon. See if you can get one of the medical professionals to help out with that.

  5. Sorry for all your hassles with insurance and doctor's. I hope it's over soon and you get the approval news you are waiting for.