Butterflyink13

Hi Anybody on this post seeing Dr. Ramanathan at Magee and had your surgery already?

My procedure is scheduled for September 2nd and I've completed every appointment except for a second apointment with the nutritionist (that's scheduled for this Wednesday). The request for my authorization was denied. Then, the Peer to Peer was denied. So an appeal was filed on July 31. Just waiting for an answer. I hate that my surgery date is this close and I don't even know if it's going to happen. I had resigned myself to take it as a sign if the appeal came back denied that I would tell the surgeion's office not to file any more appeals (she said they can file 3 times). I've changed my mind as far as that's concerned. If they have to appeal 3 times and they're all denied, then I'll take it as a sign. Otherwise, I'll always wonder "what if" ... Anybody get denied multiple times then then have an appeal approved? Just so frustrated and needed to vent.

Last week I called the insurance company every day (one day I even called twice at the suggestion of the first ins rep I spoke to - didn't make a difference ... ) They kept telling me that they have 30 days to respond to an appeal. So, my dr's office and I thought that meant we'd have an answer by August 31. Even the insurance reps I was speaking to were saying the 31st.. However we came to find out that it's 30 business days, not 30 calendar days, which would make it September 14th. I called today , not that I thought I'd get an answer, but you never know. Today they told me that they have to answer by the 7th. So with the 7th being Labor day, I should have an answer by the 8th. I've rescheduled the surgery for the 28th of this month in the hopes, again, that I'll be approved. So, I'll keep my fingers crossed that I get good news on Tuesday. Pindoctor - so glad your approval came through in time for your procedure. Having to reschedule is a pain in the butt! Jelly - I know someone who used ankle weights under her clothes when she went to weigh in. I work with her husband and he's brought it up several times. Talk about frustrating! Not something I want to hear. And, I think she's lost around 30 - 35 lbs and considers herself to be at her goal weight. Yep, annoying!

WingFan55First off, my BMI is only (if you want to say only) 37. The reasons given were that (1) they felt my sleep apnea wasn't severe enough and (2) that they felt my high blood pressure was being controlled with my current medication. My surgeon and my PCP both felt confident that I would be approved for the procedure, not that anyone can know for sure until you're actually approved. I'm not sure of the exact conversation during the Peer to Peer, but my surgeon said the insurance rep was extremely rude to him and that there was just no talking to her. Pretty sure he said the conversation ended when the insurance rep hung up on him. So that kinda has me worried. Hopefully there will be a different insurance rep who will review the appeal and they'll be in a better mood. Fingers crossed!

I called the insurance company myself today and they said they didn't see any response to my appeal yet. And that I should have an answer by the 30th. Hopeful before that since that's Sunday and will hopefully have surgery next Wednesday.

hopefully it's just a temporary postponement

So Frustrating!! I hope things straighten out soon for you. Did they say how long they want to postpone?

Hi! Just thought I'd introduce myself. I'm not too far along in the pre-op process. I have my third PCP visit and first visit with surgeon next week. Trying to get as much information (positive and negative) as I can by reading about everybody elses experiences and seeing questions and answers about some things I hadn't even thought about. Looking forward to reading about everybody's success stories and any advice that might be floating around out there.