How long can an insurance company take on making a decision?

[Slinker 1]

Hello, my insurance only had 3 requirements 1) Meet BMI criteria 2) Use in-network providers and 3) give them 2-3 weeks to make a decision. I have met all those requirements, plus I have a medical necessity: type 2 diabetes and now insulin dependent. I adamently asked about any pre-criteria, i.e. physician-supervised diet, etc. I was told no, not with my plan. The same answer was given to the surgeon's office and they were also provided with a confirmation number regarding what was required. The bariatric center had me do the usual: psych eval, pulmonology, bloodwork, primary care letter, endoscopy, dietician, meetings, etc. When all that was completed and reports compiled it was faxed to the insurance company--that was 26 days ago. I have called 3 times. The first was 1.5 weeks after submitting the file to make sure they received it and if it was complete. I was told they received everything but it was pending a decision. I called a week or so after that and was told it was with the final reviewer and to call back at 3 p.m. for the final decision. I had a meeting later that afternoon and didn't want to call back at 3 (in fear of being pissed off if it was denied and having to go to that meeting lol). So I called the next day (day 20) and the person asked if I was calling about the appeal or the MRI. I was flabbergasted. I told her no one had notified me about any MRI and I had not been made aware that my claim had been denied. She told me "I never said you were denied or approved." Now I'm thinking I'm in the twilight zone. I replied that one couldn't appeal a pending claim, nor would one appeal an approved claim. Anyway, she claimed it was a misunderstanding and that it was still pending. However, she said "you know, we are allowed 21 days to make our decision so call back next week" My surgeon's office has called since then and it is "still pending." Today is day 27. I remember someone telling me that by law insurance companies have 30 days to make their decision so a) is that true? what will happen if they don't or won't make the decision in 30 days; c) do I have to get an attorney? d) why would they do this?

Any thoughts would be appreciated. I really don't want to call them anymore because it's like them talking about arbitrary nonsense and I'm trying to discuss something very important to me. Thanks!

Sherry

Edited January 13, 2015 by Slinker

[lose2winagain 17]

I have been on pins and needles waiting. My bmi is 43 I'm diabetic, I have high blood pressure, high cholesterol and my triglycerides are thru the roof! They can approve this surgery or they can pay for my hospital stays when I stroke out or have a heart attack! I've been waiting for almost 3 weeks now!

[brandy31 32]

I think they can take up to 31 days to approve... That's what they told me when I was waiting.

Mine only took 2 weeks, though. I have United Health Care- Choice Plus