Not approved... same as DENIED?

[cheechtrish 1]

So, it has been quite the journey for me to get my sleeve. started my info session in October and i am off for two weeks starting now for the holidays, so the surgeon scheduled me for 12/21 surgery date.

went through all testing- millions, it seemed.... to finally submit everything two fridays ago-

up til friday of this past week- the insurance had not approved..i called, often, but didnt push anyone.... hard.

called friday at 400 to my surgeons office to see if they heard anything- they were closed!

so, i called the insurance co myself- the 'operator" at preapproval said that i was not approved. that the notes indicate they need more info from the dr office...

so i ask, well, i am scheduled for tuesday- if i am approved, i start my pre-op (Clear liquids only) on Sunday... what should i do?? is the info needed just results that didn't come through the fax clearly?? or is it something i cannot do by tuesday? operator says she doesnt know and that the nurse who reviewed my file is gone for the day.

so, i ask, if i am 'not approved' that info is needed.... is all hope lost? (my insurance changes 1/1/11 and the sleeve will no longer be an option fo rme. so i really want this to work- but i have no time to appeal!)

I am on clear liquid diet today though.. might be for nothing.. but i want to be ready JUST in case?!

any expereince out there to share??

[MRSKOUBiK 27]

I had the same problem. I was denied at first. They said they needed extra info. I asked what it was, and they let me know. I had everything, so I told them ok.

With my insurance company (Cigna) they said there was no need to APPEAL. You could simply send it to the AI department. (AI is for ADDITIONAL information.)

So I submitted everything on a Thursday, and was supposed to start my PRE OP on that following Monday. I didn't know what to do.

I ended up starting Pre Op just in case. And, called Monday morning to find out I was indeed approved. And, would of found out that I was PRE approved that Friday if the fax machine at work had paper in it!

That was almost two weeks ago, and my surgery is TOMORROW!

Good luck on your journey.

I think you should do the liquids just in case. It can't hurt anything.

[Von82b 0]

Hi a kinda had a similar probelm. I wasn';t denied but Cigna needed more info from the doc. All it took was one more fax and I was approved the same day. So hang in there. It could just be one sheet of paper they need.

So, it has been quite the journey for me to get my sleeve. started my info session in October and i am off for two weeks starting now for the holidays, so the surgeon scheduled me for 12/21 surgery date.

went through all testing- millions, it seemed.... to finally submit everything two fridays ago-

up til friday of this past week- the insurance had not approved..i called, often, but didnt push anyone.... hard.

called friday at 400 to my surgeons office to see if they heard anything- they were closed!

so, i called the insurance co myself- the 'operator" at preapproval said that i was not approved. that the notes indicate they need more info from the dr office...

so i ask, well, i am scheduled for tuesday- if i am approved, i start my pre-op (clear liquids only) on Sunday... what should i do?? is the info needed just results that didn't come through the fax clearly?? or is it something i cannot do by tuesday? operator says she doesnt know and that the nurse who reviewed my file is gone for the day.

so, i ask, if i am 'not approved' that info is needed.... is all hope lost? (my insurance changes 1/1/11 and the sleeve will no longer be an option fo rme. so i really want this to work- but i have no time to appeal!)

I am on clear liquid diet today though.. might be for nothing.. but i want to be ready JUST in case?!

any expereince out there to share??

[albertogunz 1]

Good luck to you. i would start on my pre-op and act as if everything were going to work out. Have faith if it's meant to be it will all come together. I definitely can relate, insurance company has added more stress in my life than anything else this year. I am going into surgery tomorrow morning and still fear that they'll pull me out of the O.R. and tell me where the was an insurance glitch.

Hang in there.

[hopeandfaith 6]

I JUST went through the SAME thing but I have BCBS. What you need to do is START calling them everyday. In my case they were going to MAIL what they needed to the doctor but I gave them a fax #. They faxed it and my doctor told me what was needed from my other doctor so I got them the information and CALLED AGAIN....saying I just want to make sure you have all the information you need....I WAS VERY VERY VERY KIND! It paid off...I HONESTLY don't think I would have been approved without pushing the issue! See it's end of the year so they WANT you to wait so you can pay your deductable again!

Everytime I started my presurgery diet I HAD PROBLEMS with my insurance and or doctor. The nurse told me drink your Protein shake for two meals until your insurance approves you. GOOD LUCK and HANG IN THERE it may be a VERY SIMPLE question that they have. KEEP US POSTED!!!