Insurance delay-help!

[pindoctor 49]

I am so frustrated right now. I have been planning my surgery since last Oct and had my pre-op on July 17. On that date day I got my surgery date of Sept 2. On Aug 5 they submitted all my stuff for preauthorization and here I am Aug 26 1 week preop, halfway through the liquid diet. My insurance company hasn't made a decision and furthermore they had no idea when they would have an answer. I have taken the time off work and have to request time off 30 days in advance. I feel like I am totally screwed and all my carefully laid out plans are coming apart. Any suggestions?

[jane13 2,256]

@@pindoctor - have to you spoke the insurance person at surgeons office? I had to have approval before I could get a surgery date.

Called the insurance company? I am sure you have done that already to see if there was something they needed...pre-op info, pre-op testing, etc.....

[pindoctor 49]

Yes I spoke with the person at the insurance office and they say that my case is "under review" and cannot give me any additional information. The insurance company implied that they had an influx of requests and that they could give me no information as to when would be reviewed. The insurance liason at my surgeons office said that Blue Cross Blue Shield Federal general takes 10 days to review these cases and it has been 20 days. She also said that in general with my insurance company they have not had problems getting approvals.

[YngGram 73]

I am there with you. My surgery was scheduled for Set. 2, all appointments were done and they submitted on the 17th. The band removal was approved that day. They also denied the revision. The reason given was that even though the band caused complications, I was non compliant since I said in the dietary consult that I didn't always follow the post bariatric diet. Of course the fact that I had days I couldn't eat anything because of the band just wasn't mentioned. Also, because my BMI is now only 33.47 and I did lose with band, I don't meet the conditions for coverage for the RNY. Now as I see it, they are punishing me for actually loosing weight with the wrong tool. I was never able to have more than 4cc in the band so I never really had the restriction to only be able to 1/2 cup or less for total success. The REAL problem is my doctor's nurse. She isn't returning my calls. I didn't know about the denial until I had called several times about instructions for my pre-op appointment at the hospital. At that time (20th) she said the doc was doing a phone call with the insurance company. Several more calls to her (no response) I called the insurance company (TRICARE) and they said they only had a request dated the 19th, and no other follow up. They offered to send it over again to that department. I again called the nurse without response so I called the nurse who does the seminars and she did a face to face with the nurse. This was on the first and she did tell me the surgery had been cancelled, but the other nurse would get back to me. Nothing again so I called on the morning of the third without response. Without doubt this has been an ugly long weekend.