You know you want it

Another insurance update, that is. I aim to please!

I still haven’t heard back from Odalys. Not a peep. Not one to take newslessness lying down, I decided to go ahead and call BCBS one more time. This morning, I spoke to a guy named Justin. Justin was helpful at first, but by the time I had explained that the surgeon’s office needed a letter that included the diagnosis and procedure codes, he was convinced the surgeon’s office was involved in insurance fraud. He just kept repeating “if they want to know what codes to use so that your claim will be paid, that’s insurance fraud!” Dude, chillax. Ain’t nobody tryin’ to defraud no insurance.

Then later in the afternoon, I stumbled upon something online that sparked an AHA! moment. I saw a “request for predetermination of benefits” from a fertility clinic to an insurance company. I thought that perhaps this might be the magic phrase, so I called BCBS again and explained to Stacey that: “my surgeon’s office sent a request for predetermination of benefits on October 10th. I got a letter in the mail saying I was authorized for a hospital stay in relation to the procedure, but my surgeon’s office has not yet received a response to their letter. I’m calling to see if any progress has been made on getting a response to the surgeon’s office.”

Stacy says, “I see that someone named Odalys called on November 20th. She spoke with Mia, and Mia sent all of your information to the medical review team again. Right now, your case is still under medical review, and a letter has not yet been sent to your surgeon’s office. Mia is going to call Odalys as soon as the letter has been generated.”

So yes, this is all still ridiculously confusing. Yes, it’s still maddening that Odalys doesn’t returns calls OR emails OR answer her freaking phone. But I do suddenly understand the difference between what the surgeon’s office has requested (a predetermination of benefits) and the first letter of approval I received (authorization for the hospital stay related to the surgery).

Stacey, the BCBS rep, assured me that I’ve already been approved, it’s just that the medical review team needs to generate the response to the surgeon’s office’s request for a predetermination of benefits.

So yeah, it’s still about as clear as mud, but even this is better than hearing NOTHING.

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3 Responses

  1. Please tell me that you have more faith in your surgeon than we all have in Odalys????

  2. Oh yes! If the surgeon was not the best in Florida, I’d have already switched to another bariatric program!

  3. Hell, Meg, where ya been? What’s going on? Did ODalys read this and tell your insurance she had no idea who you were?? It’s seven days into December already! Give me a sign!

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