Is it okay to pester my insurer?

[Trinn 139]

Hey, so, here's my situation. All the various people have signed off, so now it's just off to insurance. I talked to the team member doing the insurance submissions, and she said her goal was to submit to the insurer Blue Shield of CA, not BCBS) by the end of business yesterday.

My insurer has a 5 business day turnaround for responses on bariatric pre-auths. So, here's my question: is it okay to call the insurer and ask if it's been submitted? Can I call after the five days? I ask because we're trying to get me on the schedule before the end of August, but they can't schedule my pre-op apt and surgery until they get the approval. I'm going on vacation for part of August, so if I'm going to be on liquid diet then (my doctor will do 2 weeks) then I will need to be doing that while on vacation. I am putting all that into place (have to have my preferred Protein shakes delivered to my hotel, etc...) but I'm maybe a little impatient about the approval. :-)

Do you all call your insurer a lot? Is it okay to do it?

[*Lexie* 1,486]

I didn't but my approval came back really fast, within a few days. It doesn't hurt to call and check up on it. You do pay for this insurance so you have that right.

[Trinn 139]

So, here's what happened. I called my insurer Friday and they were super helpful, but said that no pre-auth had been filed. They even offered to call up the doctor's office to check on it for me, or to help them file. I said no, I didn't think that would help, and it was Friday anyway.

Then I wrote a message back to the insurance coordinator of my team. She's the one who wrote me that she was going to submit the claim, but hadn't. She her email had also made some "suggestions" that weren't really helpful. For example, I said that I was trying to make sure I was ready to start the 2 week liquid diet, and she said, "Well, you can get prepared by substituting one meal a day with a Protein shake. Also, you can work on the pre-surgery behaviorial recommendations. And you need to lose X pounds before surgery, anyway." Oh, and she had said, "Insurance takes 30 days to respond anyway."

I wrote her back as politely as possible and explained that no, my insurance had a 5 day turnaround max, and they expected it would be less than that. I have been having Protein shakes for two meals a day for over two months now; I'm just waiting for their go ahead to go to all liquid. I've already met my weight loss requirement, and the nutritionist found I was already in compliance with every pre-surgery recommendation.

So, it sort of disappointed me, because I felt like she had either not read my file (even though she's seen me as part of visits) or just didn't bother, or just sent me a canned response. Based on that, I'm starting to think that the team isn't really interested in getting the pre-auth in a timely manner. I've already had this person tell me that she didn't believe me that my insurance no longer needed 6 months of nutritionist visits, and that they were probably better for me anyway. She's the nurse and insurance person on the team; she doesn't sign off on anything.

So, I'm disappointed. Trying to decide if I should continue to push, or just give up and maybe try again to do surgery next year in January.

[Sharon1964 2,530]

If you haven't called your insurance again, please call them today. And if they haven't heard anything from your surgeon's office, have them call.

[Twinmomma422 54]

I called mine today to check in and found out I was approved before I got a letter. I should get it tomorrow they said. So it doesn't hurt to try. Good luck!!

[Trinn 139]

I called my insurer again. My doctor's office still hasn't submitted the pre-auth request. I'm pretty annoyed. Tried to call them, but just got sent to leave a message. *grumble* So annoyed about this.

[Sharon1964 2,530]

Call and ask for the Office Manager or Practice Manager at your surgeon's office.

[Trinn 139]

I contacted them *again* and was told that this time, they really really were submitting, and sending my file to the surgical scheduler to start getting that going.

And then of course, called my insurance company this afternoon and they said, nope, no claim filed.

At this point, I can't imagine how I'll be able to to be scheduled before the semester starts, so I'm going to end up doing this in late December or January. *sigh* Which means I have to cancel schoo-related travel for January.

All of this is after the NUT and surgeon told me at the end of July that there should be no problem getting on the schedule for a date before the end of August. *grumble*

[Jessee3897 114]

Grrr. That's awful. Sounds like the doctor's office really dropped the ball.

[Trinn 139]

Called and called and last Monday just before I went on vacation, called the medical management office of the care provider and got someone who lit a fire under the folks who were handling it. It was a good call, too, because it turns out the surgical scheduler was going on vacation and wouldn't have done it for the rest of the month!

So, Thursday I got approval, and today I talk to the backup surgical scheduler, and got a tentative Sept 1 date! He's going to talk to the surgeon and get back to me today!

[Jessee3897 114]

Great news!!!

[Trinn 139]

My date is now officially Sept 1. :-) Very very happy.

[1SlimmerMe 122]

@@Trinn Congratulations to you and your persistence! The squeaky wheel gets the oil.

[Trinn 139]

Thanks! And in case anyone wonders, I called my insurance company almost daily for a while, and they (Blue Shield of CA) were always wonderful and friendly and helpful. They never got irritated at me. They offered to do anything they could to help me with my doctor's office. The folks I really seemed to annoy a little bit were the doctor's office staff, who kept insisting it would take longer to get a pre-auth, that it probably wouldn't go through on the first time, etc. So, call your insurance company as much as you want to!