Pre-Authorization Sent In - Waiting Now

[heynowkc 329]

So I had a little snafu after finishing my 12-month program with my insurance company.

First, the insurance company had the wrong enrollment date for the 12-month program. They had me down as enrolling in June but I actually enrolled back on November 15, 2013.

Second, even though I had specifically asked (and was told no by) both the surgeon's office and my insurance about a psych eval (and sleep study) and have checked and re-checked dozens of times that I was following all of the guidelines/pre-reqs, I was only told AFTER my graduation date that I actually do need a psych eval. At that point I had already done the half-day wellness visit with my surgeon, all of my pre-op testing, weight watchers since last November, and monthly MyActiveHealth consults for 12 months. So I was completely floored by this sudden revelation. Why hadn't anyone told me before? I still don't understand.

Anyway, I found out about this on Monday of last week, completely lost it, then pulled myself together and somehow scrambled and got my psych eval done. It was really a miracle too because most of the places I called (pages and pages of listings) have like 2 month waiting lists, or couldn't see me until mid-December at the earliest, or weren't even taking new patients at all.

The good new is, that yesterday, a week after the bombshell of that news, all the paperwork for the the eval and my graduation date came through. Finally everything was in place.

Today the surgeon's office happily tells me they're sending the pre-authorization in before scheduling surgery, and that everything looks good. She has me down as wanting surgery before Christmas, and says they will definitely try to make it happen. (Because of the way our leave works where I work, I have about 2 weeks paid time off starting Dec 23rd. And my leftover sick/personal leave doesn't run out/renew until January 9th.) Then she drops another bomb and tells me, that however, it can take up to 2 weeks for approval, at which point they'll call to schedule the surgery and will "try their best" to get me in before Christmas.

I am crossing my fingers that my insurance won't take that long. I have had to get a couple of other pre-authorizations in the past that were approved the same-day over the phone, so I am really hoping they're fast on this one too. I never imagined it would take two weeks to get an approval for something that I've been working with the insurance company on for (technically over) 12 months now. I think I might call the authorization office myself tomorrow morning just to get an idea from the source itself how long they think it might take, and also maybe see if I can convince them to speed it up.

So my question is, how long have you guys experienced having to wait for that final approval once the pre-authorization request is officially submitted? And what are the odds that I won't be approved? After all of this. What are some of the reasons people get turned down? I know I meet all the qualifications and have done absolutely everything they've asked of me, so I am not that worried, but with all of the run-around I've had the past week I am not so sure anymore.

[alwaysvegas 702]

Congratulations on getting your paperwork submitted, but sorry so much stress along the way!

Insurance approval varies with insurance and time of the year, but usually with a few days to two weeks. Because it's nearing the end of the year, many people are doing last-minute doctor stuff, so the insurance company may be a bit backed up Nov-Dec.

Best of luck on your journey!

[Elode 8,093]

@@heynowkc Mine took about 8 days

[heynowkc 329]

@@alwaysvegas & @@Elode thanks for the responses. I know it's a terrible week to wish for anything to be rushed! Thanksgiving week! And I completely forgot most people's insurance plans renew with the year. Mine doesn't until mid-year. I am definitely going to put a bug in their ear and hope that they get it done quickly. At least talking to the insurance company and getting someone to give me an estimated wait time will make me feel better.

[Elode 8,093]

@@heynowkc It's hard to say since all insurance is different but try not to stress.

[heynowkc 329]

@@Elode I am doing the best I can. The silly part is that if it weren't for my leave schedule I would legitimately be happy (and even prefer) to wait a few extra weeks or even a month longer than I originally expected. It would mean I could have time to lose even more weight before surgery and get to enjoy my Christmas break instead of having to recover from surgery during it! Who knows, I might just get my wish.

[Elode 8,093]

Oh scheduling stinks!! Especially when you have to do it around an insurance company! I hope it all works out in your favor!