Fepblue Or Any Ins Question

[Grider 92]

I called last week and they said my paperwork was in, but was on hold, apparently something was missing, I called this week and whatever was missing is there but still on HOLD.. I try to get understanding from the reps what that means... but they dont seem to know. if it is all there- it should be "under review" ? Guess, I am just wondering if the terms they use mean anything at all. I'ts Black Friday -so nobodys working today, so I'll check Monday. But just wondering if anyone ever had this " ON HOLD" term used on their approval request.

[MelindaH 3]

They will assign your case to a managed care team. I have the number somewhere (although not sure if it is just for the west coast) but I will find it and messge it to you this weekend. Hang in there. It will move fast once it is in the hands of the nurses.

Melinda

[Grider 92]

I'm hanging !! How you be? how was your Thanksgiving? you ready??

I rather they say it is in for review,, reason- they say it's "on hold" when they needed the missing things, and it still says the same thing. I just do not know if they give it another term when all is there, and it moves forward. I know our base is in Jacksonville Fl. and do they still have to follow state laws? I'll take the #, cause they may have they one by me.. so thanks! It is getting cool now, 40's in the evening next week.. BRRR.

[Dulci 108]

My surgeon has an insurance coordinator and her job is to get insurance approvals. If your surgeon has a similar person, I'd call them Monday and let them know that your approval is still on hold. Perhaps if both you and your doctor are calling BCBS, they may act a bit faster. They say that the squeaky wheel gets the grease.

[Marianne390 0]

I had no problems getting approved for the surgery, but my band slipped and the surgeon had to go in and unbuckle it in October, and that too was approved by the insurance company. I am scheduled to have the band rebuckled on December 8th, but the insurance company denied the coverage for this surgery because my BMI is too low!! I lost 55 pounds originally and had another 30 or so to go, but since the band has been unbuckled I have gained back 15 pounds! Do I need to gain it ALL back so they will cover the surgery? OMG!! I am so frustrated right now and want my band back!! Any suggestions on how to convince the company that I need this surgery?

[Melinda Hohenberger 1]

I would read the policy carefully. Read page53 of the 2011 benefit plan. Do you have standard or basic? I think this criteria is for both.

You can initiate an appeal but I am not sure you have grounds for it. But you are entitled to it.

Melinda

[Grider 92]

Hi well no care management for fepblue, she said it is all at the "review board" n that is that. Cannot talk to them but, they can call me or the DR. The notes were a mess and this rep straightened it all out and came and went and said all was in place, to call thursday. I was on the phone about 30 min with her, so now I just wait till Thur and see whats going on. Im tired of it all anyhow.. will wait. How are you guys doing?