Anticipating A Denial

[BoBann 42]

It's been 2.5 weeks since submission for approval and I've heard nothing I'm really worried its going to be denied. I understand it sometimes takes longer than this but I have anthem bc and usually they are very prompt about replying. I'm probably just stressing because I want it so bad and actually depending on it.

[Artsy 48]

I'm in the same boat. I'm also anticipating getting denied i did a sleep study last week & waiting on results. If i don't have sleep apnea, there will be no approval. Do you have any co-morbidities? If you have apnea, diabetes, and a host of other things, they will probably approve.

[aliandrews 98]

I think some insurance companies have 30 days to approve. Mine approved me at 2.5 weeks, so don't fret.

[dixienms 24]

Another one in the same boat here. Trying my best not to stress over it, staying busy helps a lot. But still in the back of my mind I am hoping postively. I do have obstructive sleep apnea, was diagnosed 2 years ago. I also have diabetes so with those two I am hoping tomorrow I get that phone call I have been patiently waiting to hear. Good luck to everyone else, hopefully within this next week we all will get great news

[MinaT 669]

Mine was submitted Friday. I have sleep apnea, but refuse C-pap and use oxygen, I take Victoza for diabetes but i was diagnosed with Lupus and now I'm afraid I will be denied because of that. I was told not to worry about that though. Good Luck everyone. I'm actually going to call the insurance company Tuesday. I heard calling sometimes can speed things along.

[MeMeMEEE 206]

Have you called your insurance company? Don't wait to hear from the Dr's office or get a letter from the insurance, call!! Make sure they got the request, ask where they are in the review process, etc.

[dixienms 24]

Have you called your insurance company? Don't wait to hear from the Dr's office or get a letter from the insurance' date=' call!! Make sure they got the request, ask where they are in the review process, etc.[/quote']

I plan on calling in the morning. Never thought to call guess I got the impression that the coordinator is the only one to deal with them but I am for sure not waiting any longer. Ty for the advice

[MinaT 669]

Have you heard anything? I called BCBSIL today. The Customer Care Agent said they did receive it today (I was told Monday when I called that it could take two days for it to show up in their system). My surgeon's office said they didn't get it out and will be faxing it on Tuesday. BCBS agent said there are no notes on it yet, and it's before the medical review. She told me there was about 28 pages that they received from my doctor.

She said they are told to tell people that there could be up to 30 days to review and has had many other people calling in the past regarding bariatric services.. I asked her when I should call again, she said maybe about 7 days. I told her I'll probably call back on Monday, she said no problem.

[dixienms 24]

Still have not heard anything I am so frustrated and unnerved by how this is going. The insurance coordinator is off on Fridays but I am still calling in the morning and asking questions they probably wont like. I dont care if they do or not. If the person in charge of getting the insurance all the paperwork and she cant return my calls, well then someone else will have to step in and do her job or so I think.

[BoBann 42]

I called the insurance company (Delta) and they said the drs office had to call the physicians line at Anthem. They would not give me a customer service number. I broke down and called the surgeons office (even though they ask patients not to in their intake paperwork) and they said they hadn't heard anything but did provide me with number. SOOoooo I called Anthem and they say they have no paperwork on me!!! Aaaggghhh!!! I call the surgeons office back and they swear they faxed the auth request 3 weeks ago :( I'm so upset. I have waited so patiently and have been stressing so much. Now it starts all over this is really driving me crazy

[down50lbs 2]

Hi BoBann...I have anthem coverage as well and they are normally prompt with a response, maybe you should call them and make sure your paperwork is complete.

[BoBann 42]

Hi BoBann...I have anthem coverage as well and they are normally prompt with a response' date=' maybe you should call them and make sure your paperwork is complete.[/quote']

Thanks.... Great idea???? I will at least have peace of mind that they received it.

[Artsy 48]

Well I found out from the surgeon's office on Tuesday that I have sleep apnea and they would submit the paperwork to UHC. Haven't heard anything back yet about approval---I will call tomorrow. Best if luck to all others here.

[MinaT 669]

Good Luck Artsy.

BoBann, I'm feeling the way you are now, but you have had to wait so longer, so I get the frustration. We are all told up to 30 days for a response, but yet we read here how fast other people hear back and deep down, we're thinking, oh yeah of course I'm going to be the one that has to actually wait the 30 days and of course, I'll probably be denied.

In my head I realize the actual process takes time, I know the surgeon told me had to dictate the letter to Insurance, then someone has to type it, the other doctor (internist specialist) has to get his notes together, the nurses, the classes, the medical records & notes from, then the coordinator has to gather the insurance paperwork, and fax out all the papers. The fax machine at the insurance company is probably a mess like most offices, where someone has to get all the paperwork together, it has to be assigned, a file made up and then sent to the medical review panel, and I'm sure it goes emergency situations to elective cases, like bariatric, so in my head I realize the process isn't all that simple.

I am not sure why I am so impatient now. I guess since beginning the process by making the appointment in October, waiting for the first appointment, then having to go monthly for over six months, getting all my reports from all my doctors, sitting in on WLS "is it right for me", sitting in group meetings, spending six months of writing everything I have eaten down, waiting for the final meeting with the surgeon eventually takes the toll. Every month, I have received a new date, something to look forward to...a finish line. Now, we sit so there is no real direction. It's out of our hands. We sit and wait for a response from Insurance, then we are back to the appointments again and we are again moving forward. Surgery date, pre-op diet, pre-op testing, surgery date. I think that is what the big deal is with me, working hard for over six months to sit and wait.

In my heart I realize it's a lifestyle choice and a lifestyle decision...this is for life, I'm making a choice to have a surgery that could result in pain, complications and there are people that have died from complications, so that's out of my hands too. I decided to work harder at chewing my food, trying to stay below 40 gm carbs, not drinking after meals for 1/2 hour, and exercising even more during this time. I'm even throwing in a second shake for lunch to try to make the transition a little easier. I have lost between 8-10 lbs. per month on my own, following the diet guidelines given to me. If I get denied and I can keep this up, then I'm still better off than I was six months ago, and I hope I will do my best not to get discouraged and try to keep up the with the 800-1000 calorie diet and I may get there a little slower without the sleeve, but I suppose eventually I'll get there.

Good luck and keep me posted if you guys hear anything.

[BoBann 42]

Okay...

I called this morning and the insurance has received the paperwork. Keeping my fingers crossed.