Hilarity Ensues

Well, I don’t have to wait on that faxed letter after all. It was in the mailbox when I got home yesterday. And guess what? IT’S ANOTHER FREAKING PRE-CERTIFICATION FOR AN IN-PATIENT HOSPITAL STAY. Not what I need. Frustrating, yes?

I know I’ll have to fax the letter to Odalys since she hasn’t received her copy yet. And I know it won’t be what she needed, and I’ll have to keep working on it.

So to be proactive, I went ahead and called BCBS on my drive to work this morning. I spoke to Felicia in Benefits and explained what I needed. Toward the end of the explanation, she said, “I’m sorry, but I just have to ask, what does your surgeon hope to gain by receiving this letter?” I said, “Frankly, I don’t know. I just know that I can’t have surgery without it.”

She put me on hold. For like forever. Then we she came back, she said, “How does this sound?” and proceeded to read the following:

Dear Ms. Griffin,

Thank you for your recent inquiry concerning benefit coverage for Gastric Bypass. It would appear that based on the information previously reviewed by medical review Ms. Griffin has successfully completed the criteria outlined in Medical Policy G-24 and has been approved for the bypass procedure.

Our records indicate that Gastric Bypass is an eligible procedure according to the patient’s Group Medical Plan.

If we can be of further assistance, please contact us as the number listed below.

The letter was on my desk by the time I arrived to my office at 9am. Now that letter, combined with the pre-certification letter for an inpatient admission at Ocala Regional Medical Center for 01/09/07 for provider Muhammad A Jawad ought to have this crap covered.

I faxed the info to Odalys and asked her to let me know if this meets their criteria. I have confirmation that she has received the fax, so now I’m just waiting on a call back. Let’s hope this is the end of the line!


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