Questions About Insurance Approval And Time Off

[Jellyfish 17]

Hello. First post here but I've been lurking for a while. I'm normally really shy (shy over a message board isn't that silly!?), but I decided that if I was going to be serious I needed to go ahead and sign up here. You guys are so helpful and supportive of others, makes me smile even reading other peoples' posts.

So I have a couple questions. I was doing a six month supervised dieting to get approved through my insurance (Cigna) when all the sudden I get a call last week that !! Cigna has lowered their requirement froim six months to three!! And I've already done three!! I'm with True Results in Houston and I can't tell you how appreciative I am that they called me instead of waiting until my next appointment to let me find out. I know they're in this to make money blah blah, but still it was awesome of them to take the time to do that for me.They had been really on me to get all of the other requirements done early and I'm SO glad I did! The EGD is done, the psych is done, sleep study is done, I have the letter from my primary physician. The only thing left is the letter saying I'm good to go for surgery and the blood work, which they're going to do there on Wednesday.

My questions are, how long do you guys think it will take for the insurance to give me an approval (fingers crossed) if the information is submitted Wednesday? I'd REALLY love to have the surgery third week in June but is that not enough time? Will they schedule a preliminary surgery date for me on Wednesday and we'll just hope I get approval by that date? I'm terrified that I won't get approved even though I meet all of the requirements, just from reading the horror stories on here... and I still feel like Cigna lowering their requirement feels just too good to be true. Anyway, my next question was how much recovery time those of you with sit down jobs needed? The only other major surgery I've ever had was a c-section and I bounced back from that in no time. My job is very easy, not physically taxing at all, I just sit down and type or answer phones all day. I'm hoping to get the surgery on a Monday and not come back to work until the next Tuesday .The thing is, I can't be out the first week of July due to my co-workers being on scheduled vacation already. I know I should probably just wait until the second week in July to be SURE I can have enough time off... but I'm just SO anxious to get this thing started. I'm losing sleep at night and everything it's so pathetic! I'm 26 and in reasonable shape other than the jiggly bits, a week or two off should be enough time for an easy sit down job right? Thanks for any advice!

[shues138 35]

Welcome to lap band talk!! It's such a great wealth of information!

I work at a hospital and I deal with insurance companies and authorizations so I'll tell you what would happen at our facility but its not a text book situation since every doctor, facility, patient and insurance company is different.

Usually the md will have a tenative surgery date so that when they submit the auth to the insurance company it'll light a fire under the insurance companies behinds to get the ball rolling and review your case. Most insurance companies say it'll take 30 days to get an authorization but its not always the case. Once the mds office tells you they submitted the clinical info to the insurance company wait 48 hours and get on the phone with your insurance company. Ask them to check the status of your authorization and get a pending authorization number as well since it'll make the whole process easier when calling back the insurance company. Some people may disagree with me on this in regards to calling the insurance company but you pay for your benefits and you have every right to find out what's going on.

In regards to time off when I had my surgery I took a week off from work (i was a hairstylist at the time) I still had one more semester of university left so I still had to go to class, I went back to class the Monday after my surgery (my surgery was on a friday). It was tough but manageable. I have an office job now and I would probably take a week off just to get adjusted to everything. Not only did your body go through the major trauma of surgery but you're also going to be dealing with emotional issues too I had times where I thought to myself what did I do???? My suggestion in regards to time off from work is take a week off but if you feel up to it see if you can go back to work for like a half day and see how you feel.

Good luck with your journey and if you have any questions don't hesitate to ask!

[yvonne74 73]

Every insurance is different but I got my approval back in 3 days which my Dr office said was amazingly quick. If you have a sit down job, I would say a week is plenty of time off. Just make sure you get up frequently to walk around/stretch your legs. Good Luck!

[erin313 44]

My approval took about 14 days and my insurance company even requested more information. I think 14 days is an average wait. Call your insurance company and ask them how many days it takes. See if you can find out the name of the person who will make the decision and call him/her to follow up after your docs office sends everything in.

Do you have to go on a pre-op diet? How far out will you need to start that is you have one? Most offices will not schedule your surgery until they have the actual approval from your insurance company.

[Jellyfish 17]

Thanks for the quick replies! I'm glad to hear that a week should be enough time, I'l be trying to push for a June surgery date then. The clinic told me that my insurance company tends to take the full thirty days unfortunately, but I've seen other people on here say that they were real quick about it so, fingers crossed maybe I'll get lucky again! Has anyone ever had a negative outcome from pestering the insurance agents? I guess I worry that they'll deny me because I annoy them. Maybe that's unreasonable.

[shues138 35]

They cannot deny you for checking on the status of your authorization. Like I stated prior when you're paying hundreds of dollars a month for insurance you have every right to know what's going on with your healthcare. If a rep says it'll delay the approval process that's a total lie as well and if a rep tells you that ask to speak with their supervisor immediately. Denials for an approval have to be justified. They can't deny bc the subscriber inquired too much about his/her authorization status. It would be like a contract exclusion or not medically necessary or the md didn't submit enough clinical.....

[Jellyfish 17]

Thanks, it's reassuring to hear that coming with someone who has experience dealing with insurance companies. Maybe bugging them will make me feel better too, because the wait is killing me already!!

Erin: I have been doing the supervised dieting for three months and I do have a two week pre-op diet. I'm sticking to that now just in case they can get me in there earlier, I don't want to give them any hesitations. My diet's pretty easy fortunately, just 1200 calories a day, low carb, low fat, plenty of protien. I only have to do a liquid diet for the first day pre-op, I can handle that. 14 days would be just fine, I hope they approve me that quick! We found out I have a hiatal hernia too so I have more than a few reasons for wanting this to happen quick... the heartburn is killing me! Ugh!

[Sojourner 2,446]

Every insurance company and every medical practice are different; there is no "one size fits all" or to anticipate that just because another forum member had a fast approval turnaround, you will also.

I did not see anyone mention the 2 weeks of liquid diet required by many doctors prior to surgery...which would not start until you had your approval and a firm date for your procedure. Many physicians also require you to be under a certain weight to move forward with your surgery...do you have that number yet? Have you met that requirement yet?

I'm not trying to place a damper on your enthusiasm, I only want to share the realities that there are more factors involved with scheduling your procedure than just picking a date based on the requirements of your work schedule.

Your mileage may vary...

[yvonne74 73]

Every insurance company and every medical practice are different; there is no "one size fits all" or to anticipate that just because another forum member had a fast approval turnaround, you will also.

I did not see anyone mention the 2 weeks of liquid diet required by many doctors prior to surgery...which would not start until you had your approval and a firm date for your procedure. Many physicians also require you to be under a certain weight to move forward with your surgery...do you have that number yet? Have you met that requirement yet?

I'm not trying to place a damper on your enthusiasm, I only want to share the realities that there are more factors involved with scheduling your procedure than just picking a date based on the requirements of your work schedule.

Your mileage may vary...

My dr did not require me to be under a certain weight in fact, they called me to tell me to begin the pre-op diet and didn't see me again until I was in the OR. Some doctors don't require a pre-op diet at all. My Dr's office had me start the diet before I had my approval since I knew what day I wanted to have my surgery on but we had a date already picked out.

[Sojourner 2,446]

My dr did not require me to be under a certain weight in fact, they called me to tell me to begin the pre-op diet and didn't see me again until I was in the OR. Some doctors don't require a pre-op diet at all. My Dr's office had me start the diet before I had my approval since I knew what day I wanted to have my surgery on but we had a date already picked out.

I understand that...AND if you read my post in it's entirety, I wrote that there are differences in medical practices...AND that one's mileage may vary.

That is reference to the realities that a doctor's approach to their practice in medicine will have variations. Also, we are all individuals, and our individual experiences will not be identical.

Your experience was different from mine...I wrote based on the reality that from reading this forum for over a year, there are many differences of note between between doctors, the level of nutrition education given to patients pre-op, and that every insurance company has their unique policies governing their approval processes...

[FLHgal 68]

Each Dr. is different as are the insurance companies....I had a fast approval.. about 4 days.

There are soooo many people involved in the process; if one drops the ball is slows everyone down.

I had surgery on Wed. and returned to work on Monday.

Good Luck.

[hopingtobebandedsoon 89]

I have Cigna and was approved in one week, once my doctor submitting the paper work i called Cigna to get status...the rep told me they have a denial or approval within 5 days and she was right, i called back 5 days later and was told it was approved...my advice would be to call Cigna ask for the precert depart and they will give u status..good luck.

[bandready 0]

Hello. First post here but I've been lurking for a while. I'm normally really shy (shy over a message board isn't that silly!?)' date=' but I decided that if I was going to be serious I needed to go ahead and sign up here. You guys are so helpful and supportive of others, makes me smile even reading other peoples' posts.

So I have a couple questions. I was doing a six month supervised dieting to get approved through my insurance (Cigna) when all the sudden I get a call last week that !! Cigna has lowered their requirement froim six months to three!! And I've already done three!! I'm with True Results in Houston and I can't tell you how appreciative I am that they called me instead of waiting until my next appointment to let me find out. I know they're in this to make money blah blah, but still it was awesome of them to take the time to do that for me.They had been really on me to get all of the other requirements done early and I'm SO glad I did! The EGD is done, the psych is done, sleep study is done, I have the letter from my primary physician. The only thing left is the letter saying I'm good to go for surgery and the blood work, which they're going to do there on Wednesday.

My questions are, how long do you guys think it will take for the insurance to give me an approval (fingers crossed) if the information is submitted Wednesday? I'd REALLY love to have the surgery third week in June but is that not enough time? Will they schedule a preliminary surgery date for me on Wednesday and we'll just hope I get approval by that date? I'm terrified that I won't get approved even though I meet all of the requirements, just from reading the horror stories on here... and I still feel like Cigna lowering their requirement feels just too good to be true. Anyway, my next question was how much recovery time those of you with sit down jobs needed? The only other major surgery I've ever had was a c-section and I bounced back from that in no time. My job is very easy, not physically taxing at all, I just sit down and type or answer phones all day. I'm hoping to get the surgery on a Monday and not come back to work until the next Tuesday .The thing is, I can't be out the first week of July due to my co-workers being on scheduled vacation already. I know I should probably just wait until the second week in July to be SURE I can have enough time off... but I'm just SO anxious to get this thing started. I'm losing sleep at night and everything it's so pathetic! I'm 26 and in reasonable shape other than the jiggly bits, a week or two off should be enough time for an easy sit down job right? Thanks for any advice![/quote']

I know how you feel,I been waiting on my approval 5wks and three days.Every time I call which is twice a week they tell me it is being reviewed and that they have 4 to six weeks to authorize or deny it.

[NWgirl 574]

I waited for two weeks after submission to call and check. The next day, I got a call back saying I was approved. I believe the insurance companies have 30 days to respond to a pre-authorization...

[Cocoabean 430]

I am in California. They have 30 days to respond, business days, that is. Mine was submitted just before Thanksgiving. By the time it all went back and forth with all the holidays, it was mid-January before I heard back. My surgeon's schedule was booked a month ahead. I made the appointment for my pre-op visit and to begin my 2-week pre-op diet.

Does your surgeon have time on his schedule for June? Once you have approval you have to get onto the surgical schedule. Mine was a month out, yours might not be. You can ask about a pre-op diet and make arrangements to start it with a proposed June surgery date. If approval doesn't come through, no harm no foul. Or if you don't have to do a pre-op, then no worries. But if your approval doesn't come through until June 15 and you want surgery June 20, and you should have been on a 2-week pre-op diet..you have troubles.