Approval/denial DELAYS due to holiday?

[hurley911 59]

Anyone anyone? This is the latest from the insurance company daily call report.....

[chitowngirl 886]

It doesn't surprise me. A lot of people are rushing to get their medical stuff done before the end of the year and so they don't have to pay their deductibles again. So this tends to be the busy season for insurance companies. It doesn't get any easier after the new year it is also busy at that time. These request do take time. Just keep calling, try every other day. Be nice and just explain as nicely about how anxious you are and sometimes you may get a rep on the phone who will try to push thing through a little bit faster.

[MeMeMEEE 206]

Yes, it can have a delay affect - it's a time of year alot of people are on vacation as well as many people are submitting claims they have for the year.

[hurley911 59]

Thank you dr responding.. Submitted back in sept... Just figured I would have an answer by now. 3 1/2 months! I did my diet so didn't have to do that got them everything they asked for? And nothing call everyday ... Now it escalated to a level 3 as my case worker has said it would be done soon and then weeks go by.. Supervisor called me Friday and said he just needs to review my diet clinical notes and receipts etc... Several pages....so just waiting impatiently.. Of coarse will not be getting the surgery if approved before the end of the year... First let down...now just hoping for approval ASAP...so I can schedule when they can get me in...I'm sure Jan is filing up fast... Anyway thanks again... Wondering if anyone else is experiencing this or have been told holidays = delays...

[hurley911 59]

Ins= BCBS of Alabama

[mrslovelady 5]

Hurley- I work for said insurance company- just not the Alabama branch. You might want to call bcbs of Alabama and seen if they may be needing additional info. That would be my first step. Tell them you need to check status on a submitted predetermination and if they need additional info you want to ask them what additional info is needed and then contract your Dr office and let them know what bcbs is needing. It usually doesn't take that long unless they are needing more info or more supporting documentation from your Dr.

Hope this helps.

[MeMeMEEE 206]

Yes, I am the same as Ms above - again - not Alabama, but that is a LONG time - call them and make sure it was received!!

[hurley911 59]

I call every day and speak to someone.. It was the supervisor that said to me it's delayed with holidays and everyone trying to get approved before end of the year.....it was escalated to level three supervisor because of this outstanding time.. They needed things here and there along the way but the sup on Friday told me he has reviewed everything this far but the 6 month diet stuff on file... He promised to let me know if anything else needed but as of now nothing.... I'm so tired of waiting and feel like this is totally unacceptable!

[Heyher 581]

Every plan has a time limit. If its past what your plan allows, you are well within reason to file a complaint. Even if it has been escalated, if its the first submission most plans have 30-45 days max when all info has been submitted.

[hurley911 59]

Thank you for the responses and tips... I called again today and asked specific questions about timeline/deadlines and what the policies are.... I asked her if they refrigerated every time they ask/receive more info they request... She said it has been 27 days since the clinical notes from the dr... Came in... They have 45 days... To complete or I can file complaint... She said I should be hearing something soon, but who knows... At least there is a timeline we are both aware of that I now know about... Thanks... I guess I will continue to wait... Oh and so far no new info needed ...

[hurley911 59]

Retriggered*