Approval Problems

[AmberMc03 59]

The insurance coordinator from my surgeons office didn't submit my stuff for approval! My last visit was may 19 and the surgeons assistant said she submitted the task to the insurance coordinator to submit to Aetna and I should follow up in 2 weeks. I called Aetna today to follow up with them and they have absolutely no record of a request for surgery approval for me! Because of my intense work schedule I needed to have surgery the week of June 20th. Now even if they submit today Aetna has 14 days to respond and then there might not be availability at the hospital for that week. I don't know what to do now... I can't afford to self pay!

[heidikat72 935]

check to make sure your surgeon's office didn't actually submit. Did you just talk to customer service at Aetna?

I was running into the same thing this week and getting furious. Independence Blue Cross kept telling me no record of anything being submitted even when I sat on hold for an hour yesterday waiting to get through to the actual pre-authorizations department. My surgeon's insurance coordinator finally called me back this morning and assured me that it was sent over last week but that they have a specific person at my insurance that they send it to for bariatric surgery clearance and it doesn't actually get entered into the Blue Cross computer system upon receipt of the file but only after the file has been reviewed. That's why when I call, they say they haven't received it. But I should have my approval today.

[AmberMc03 59]

The coordinator called back and said she didn't submit because she hadn't heard from me that I did the NUT class. I did it on 3/18 in her office!!! She had it in my file she just chose not to look for it. After April 6 upper EGD I was finished with all the requirements except the last 2 weight management visit. I did that on purpose so that she could submit the day I weighed my last time and then the approval could have been back this week! So now she said she submitted it and called and got a case #. They still won't make it a priority review because WLS is elective. So we will see what happens. I am going to call next week to my insurance and check the status. Every day if I have to. If I have to put off surgery I'm afraid I'll talk myself out of it

[AmberMc03 59]

Update:::: my surgery was approved the same day the coordinator finally submitted! I am now waiting for the scheduler to call me with a pre-op and surgery date! Eekkk!!!! It's getting real now!