The wait game!

[lifsvr74 31]

I have UHC as secondary and they said it wasn't covered from day 1

[Steph~L~16 168]

What insurance do you all have? I was just denied after I did everything that my team was told by insurance now they say I did need the 6 month diet or proof in past 2 years. It's been 8 months. I could have been doing it all along. Am considering going to Mexico for surgery now

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I have United Health Care. They have been good- just the surgeon's office was my struggle.

Sent from my iPhone using the BariatricPal App

[Valentina 2,642]

I'm in the same boat. I called 2/23 and insurance indicated they had nothing on file when MD office said they sent 2/17. I called insurance (UHC) again on 2/26 and spoke with the care management dept who confirmed receipt on 2/17. Case still in review but they did tell me the surgery date is 3/20 which I didn't know.. I spoke with a man who kind of pissed me off but I didn't say anything because I didn't want him to do anything to sabotage my process. I made the comment to him that "I just wanted to be sure the doctors office submitted the paperwork." He says to me "if you can't trust your office to send the paperwork when they say they did do trust them to do surgery.?" I wanted to tell him my insurance doesn't give me the option as to what Doctor I can use, but I didn't. So I'm still waiting. He suggested I call back Monday.

Great job! We have to pick our battles. Was he out of line? Sure was! Would I have liked to take him to task for his unprofessional behavior? Hell Yeh!!,,but what you did was perfect. So, call back on Monday and maybe be just a wee bit more nudgingly assertive. Great job!!!

I'm in the same boat. I called 2/23 and insurance indicated they had nothing on file when MD office said they sent 2/17. I called insurance (UHC) again on 2/26 and spoke with the care management dept who confirmed receipt on 2/17. Case still in review but they did tell me the surgery date is 3/20 which I didn't know.. I spoke with a man who kind of pissed me off but I didn't say anything because I didn't want him to do anything to sabotage my process. I made the comment to him that "I just wanted to be sure the doctors office submitted the paperwork." He says to me "if you can't trust your office to send the paperwork when they say they did do trust them to do surgery.?" I wanted to tell him my insurance doesn't give me the option as to what Doctor I can use, but I didn't. So I'm still waiting. He suggested I call back Monday.

Great job! We have to pick our battles. Was he out of line? Sure was! Would I have liked to take him to task for his unprofessional behavior? Hell Yeh!!,,but what you did was perfect. So, call back on Monday and maybe be just a wee bit more nudgingly assertive. Great job!!!

[Bedwards32 98]

I have Empire BCBS.

[Andrea Guadiana 38]

I'm in the same boat with you all. I have Anthem BCBS/ca and I was denied initially. The insurance company said that the reason they denied me was because my initial consultation with the surgeon didn't appear to state obvious weight loss goals and that too much time had passed since the initial consult and the time my surgeon's office submitted for approval. smh... I think that was bs, yet I went back to my surgeon's office for another consult and the doctor made thorough notes this time indicating exactly why I need the surgery (pre-diabetic, sleep apnea, bmi of 41.5) and that I had passed my psych eval and completed 6 months of supervised diet with a licensed dietitian. My case mgr said she submitted the appeal to insurance on 2/18. Yet, today I called my insurance company and they said they never received an appeal letter. They only had correspondence showing that my case mgr called for the fax number to fax the letter and paperwork. I called my case mgr, yet she is in clinic today. I emailed her. Hopefully I will hear something soon. I feel like my surgeon's office has been giving me the run around from the beginning.

[Bedwards32 98]

Well after 4 emails to my surgery coordinator, she finally replied and said it could take up to 30-60 days before we heard anything, my response was that I understood that, but insurance is still saying they haven't received my paperwork for approval and it's been 2 wks! She then replied she would call them today and let me know what they say...guess who didn't hear from her ????

[Sandra86says 92]

Well after 4 emails to my surgery coordinator, she finally replied and said it could take up to 30-60 days before we heard anything, my response was that I understood that, but insurance is still saying they haven't received my paperwork for approval and it's been 2 wks! She then replied she would call them today and let me know what they say...guess who didn't hear from her ????

How frustrating! Im going through the same thing. Submitted for the 3rd time last week because my Medical Group wasn't "happy" with my PCPs notes for the 6th month diet. My PCP and I rewrote the notes and made them more "clear". This process has been so overwhelming. I'm so tried of waiting!! I'll say a prayer for both of us! ❤️

[Bedwards32 98]

Guys are you tired of my whining yet? So the latest I called insurance again today and they still aren't showing my paperwork on their end. I emailed my surgery coordinator again today bc I hadn't heard from her since she said she would call them yesterday, I asked her if she had heard anything about what is going on and she said she was still waiting for my insurance to return her call. OMG what is going on!!!! Where the heck is my paperwork we are working on week 3 and I have absolutely no clue what is going on ????

[Sandra86says 92]

Guys are you tired of my whining yet? So the latest I called insurance again today and they still aren't showing my paperwork on their end. I emailed my surgery coordinator again today bc I hadn't heard from her since she said she would call them yesterday, I asked her if she had heard anything about what is going on and she said she was still waiting for my insurance to return her call. OMG what is going on!!!! Where the heck is my paperwork we are working on week 3 and I have absolutely no clue what is going on ????

Ugh!!! How annoying!! Very similar situations were going through! Hope this nightmare ends soon for both of us!! I'm so tired of waiting!

[Bedwards32 98]

Guys are you tired of my whining yet? So the latest I called insurance again today and they still aren't showing my paperwork on their end. I emailed my surgery coordinator again today bc I hadn't heard from her since she said she would call them yesterday, I asked her if she had heard anything about what is going on and she said she was still waiting for my insurance to return her call. OMG what is going on!!!! Where the heck is my paperwork we are working on week 3 and I have absolutely no clue what is going on

Ugh!!! How annoying!! Very similar situations were going through! Hope this nightmare ends soon for both of us!! I'm so tired of waiting!

It's not the waiting that's bothering me it's the fact I can't get a straight answer as to what is going on with my paperwork, I just want to hear they have my paperwork.

[Andrea Guadiana 38]

Well, I just heard back from my case manager at the surgeon's office and she confirmed that the insurance company did receive the paperwork for my appeal and that she was informed that all paperwork is stamped with the time and date of receipt, yet the paperwork may not get scanned into the system nor updated until up to 21 days later because they receive so many claims and requests each day. I called the insurance company to verify this and they do have my paperwork and my appeal is now "under review". I'm praying that I get approved. I'm so worried because although I lost weight during my 6-month supervised diet, I've gained around 15 lbs since then. But, that's a totally separate issue. Hopefully your insurance has received your request as well and they just haven't had a chance to update their system yet.

[Valentina 2,642]

Well after 4 emails to my surgery coordinator, she finally replied and said it could take up to 30-60 days before we heard anything, my response was that I understood that, but insurance is still saying they haven't received my paperwork for approval and it's been 2 wks! She then replied she would call them today and let me know what they say...guess who didn't hear from her

How frustrating! Im going through the same thing. Submitted for the 3rd time last week because my Medical Group wasn't "happy" with my PCPs notes for the 6th month diet. My PCP and I rewrote the notes and made them more "clear". This process has been so overwhelming. I'm so tried of waiting!! I'll say a prayer for both of us! ❤

Sometimes we have to "come in through the back door". Try calling the insurance company and ask them, "what wording do you need to see within my doctor's notes? Some insurance companies even have a "template" which asks all the right questions to ensure all of the right answers.

This works. I used it for the patients that had "prickly" insurance companies that wouldn't approve any procedure until they saw "the magic words".

Keep in mind that most of the time the people who receive the approval requests are NOT medically orientated individuals. Not fault of theirs. They are just not "allowed" to approve any request that does not contain certain verbiage.

Also, once again---a one on one DOCTOR conference call. Just make sure that your doctor is actually speaking with a MD.

Good luck. Give the above a try. Can't hurt!

Keep us posted. We CARE!

[Bedwards32 98]

All of my paperwork had to be resubmitted, bc my surgery coordinator was told one thing and then was told protocol was changed . I had a similar incident trying to get my cpap machine. So I knew something was not right, now to wait some more.

[Marie2016 87]

Whats new Bedwards32? approved yet?

[Bedwards32 98]

Whats new Bedwards32? approved yet?

All my paperwork had to be resubmitted today, my insurance has issues apparently.