how long is approved insurance good for before getting surgery

[trekker954 421]

I was approved back in mid January by BCBS, but had more tests results we had to wait longer than expected. Then I had multiple work trips to Asia, I had to take. My work is basically a lot of foreign travel and I did not want to risk being that far away. Now I'm ready to set up a surgery and even moreso if I can wait until early August because I won't have any travel until October. I've called my doctors office and the nurse said no worries, she'll get back to me after she reviews my package.. I didn't hear back and was hoping I'd hear so not to fret over this all weekend.

[kmorri 1,689]

When the initial authorization request from the provider is submitted to the insurance company they include an "expected" surgery date.............if it was approved, most likely all they will have to do is update the date on the authorization request......However, there may be some tests or visits that are time sensitive and have to be redone if too much time passed............(my knowledge comes from me retiring from BCBS of Florida back in September after working there for 29 years).

[trekker954 421]

Congratulations on your retirement. I hope to retire also at the end of the year, or possibly go as long as mid year 2017.

Good to hear. Yes, they had put a Jan. 20 expected date. The approval was for 5 night hospital, although I was told that is put down in case of complications and its typically only 1 or 2 nights.

I was still awaiting test results that would have not been returned until the following week. The admin gal, who handles scheduling, told me, oh its okay, you can have the surgery without the test results. I had quite a blowout with that admin gal. I orginally wanted the surgery in Dec but the clinic required so many invasive and expensive tests that it got ridiculous, IMHO. The pulmonary doctor results came back fine, but then he's say, you should see a cardiologist. The cardiologist would say your tests were fine, but you should see a Gastroenterologist, he'd order more tests and say, they came back fine but you should see a Hepatologist. You see where this is going? I started to feel like hospital just wanted to rack up more money. So by late January (one month of tests) I had paid out of pocket $650 for co-pays (BCBS).

So when the admin gal wanted me to go under the knife before all tests results were in, I lost it. Insisting if my surgeon ordered this test last minute (he actually even wanted me to see a specific doctor who wasn't available for two months - so I saw someone else); I wanted to wait until all test results were in which was going to overlap the Jan. 20 date. Then I had to travel for work, (three seperate trips to Asia between Feb and May 27), so I just put it off until I had time, which is in early August. I can take up to six weeks off if I want to. I'm older so I think that is important.

I expect and am hoping its just a chest x-ray and blood work that will need updating. I do hope the nurse (not the admin gal) calls me back on Monday with good news. There is no way, I'm going to jump through all those hoops to get the insurance approval done again.

Edited June 5, 2016 by trekker954

[Icantbelieveit 955]

They will want an updated cardiac clearance for sure. My people said everything I needed for approval but toke me to hild off on the cardiac clearance as close as possible to surgery or I would need to do it again.

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[Read2016 658]

The admin girl must be nutty, why order test to clear you for surgery than offer you surgery without the test result? Seems to be a sure way to lead to a malpractice lawsuit... Your were 100% right to have a blow out.

"We can't solve problems by using the same kind of thinking we used when we created them"

Einstein

Edited June 5, 2016 by nyteacher125

[trekker954 421]

Exactly, why order all those tests? And I was pretty healthy. I felt two things as I was being probbed and prodded. One was it was just a money making scheme and two, that each specialist wanted to cover their a**, and not be the final say.

In all honesty, I always wanted to get a full work up since I'm 62 now. The past ten years being 100 pounds overweight, but otherwise healthy I'd watch Dr. Oz or whomever and see test results for people who had some invasive procedures and results discussed.

It all started because during a routine visit to my PCP who had me on Phentermine said, I had an irregular pulse and wanted to take me off phentermine and see a Cardiologist. However at the same time, I had taken the WLS seminar 4 months prior, so I was considering this. And my appt with WLS Surgeon and Cardiologist were about the same time. So that is how it all started and I couldn't get cleared for WLS while all these other doctors were requiring another test before they would clear me for the WLS. It was so insane.

If I wasn't so invested in this hospital at this point, I may have looked at other options. But I also trust the surgeon. He is actually a fixer for others who run into complications. I'm just sorry I don't care for some of his staff or their shenanigans.

I was so ready to have this done late January and when I had that blow out with the scheduler, I was left sobbing on the phone so afraid to do this now without the last test results or just go ahead because the timing was perfect and I was ready. She just felt, come in for the surgery in two days and if the results aren't back or showed a problem, I'd just go home. WTF. I also asked where is my requested letter to give to my work. She said just tell them. Again WTF.

I had been doing the pre-op liquid diet for three weeks prior, lost about 15 pounds. During this blow out we were on the phone as I had just had my complete abdominal ultrasound leaving the hospital and I just sobbed to cancel THAT date, I wanted all results back, although I had no reason to expect anything bad. I drove immediately to a nearby TGIF and ordered a big lunch and margarita and sat there alone, amazed at what just had happened.

[trekker954 421]

Doctor's office called. All they need from me is updated EKG and lab workup.

[Icantbelieveit 955]

Exactly what I said. Good

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[Christinamo7 4,042]

it varies with insurance plans.

for my policy once I got approval it was good for 12 months, and I had surgery the month after the approval.

[trekker954 421]

This was the doctors nurse. When I wanted to confirm the insurance approval was sstill good, she said I need to check with the insurance girl, but likely they'll just push the date back. That probably should have been done back in January or February. Oh well. It is what it is.

[trekker954 421]

My surgeon's office is driving me crazy. They came back and said BCBS said my approval is expired, and they will get a call back saying what I'd need to repeat, she wasn't sure if it was the 6 month diet and/or psyc eval. WHAT?? I said, I wasn't going through all that again. Two days later, today, she calls and says I have BCBS on the phone, its the same nurse who approved it originally so if I answer the questions correctly now, she'll approve. She asked if I've been still dieting and if I started smoking or have undergone some stressful thing in my life. Then asked my current weight and height. She called me back in 5 minutes and said its approved. geez. I'll be scheduled for early August.