Dr Submitted(pprwrk) as Urgent

[TXMom*3 7]

Hi,

I have United Healthcare Choice Plus...My Dr submitted to Insurance 5 days ago, But is calling to have them mark as Urgent! (to get it processed faster)...

I was wondering if anyone else had Submitted as Urgent, and How long it took after to get an Answer?!

Thanks

[GreenTealael 25,385]

No experience with this, but awesome Surgeon.

[Matt Z 4,139]

28 minutes ago, TXMom*3 said:

Hi,

I have United Healthcare Choice Plus...My Dr submitted to Insurance 5 days ago, But is calling to have them mark as Urgent! (to get it processed faster)...

I was wondering if anyone else had Submitted as Urgent, and How long it took after to get an Answer?!

Thanks

Insurance reviews take 2 weeks on average, no matter the urgency marked. If it was a real emergency or had a high urgency for safety reasons, then the authorization would happen over the phone first, then in writing. Insurance companies are notorious for dragging their feet.

[LadySin 404]

I work for an Insurance. I work in a department that specifically handles prior authorizations and well as appeals. We don't drag our feet, even though it may seem like it. But boy do we get busy as all hell. Especially around this time of year. I don't know the rules for you particular insurance company but for mine when a member or provider requests an urgent prior auth we ask them a few questions first. Is the patient's life in jeopardy if they don't have whatever they are requesting done urgent? Can they go to the ER? If there life isn't on the line we then ask if they are in unbearable pain. If either one is a yes we process all urgent within 72 hours. Some stuff we have to process same day like chemo treatments and fertility procedures. We don't fight the provider or patient's usually. If they answer yes to the questions we take their word for it.

So remember folks YOU CAN ASK YOUR INSURANCE PROVIDER FOR YOUR CASE TO BE EXPEDITED. You DO NOT have to ask your provider. Just remember to answer those questions correctly. Again I don't know the rules for every company but in order to even get an urgent you also have to ask for it within 10 days of the case submission.

Edited December 5, 2018 by LadySin

[Jazzy1125 1,010]

I havent had experience with this but wish you the best of luck getting it approved quickly.

[anonbaribabe 236]

7 hours ago, LadySin said:

I work for an Insurance. I work in a department that specifically handles prior authorizations and well as appeals. We don't drag our feet, even though it may seem like it. But boy do we get busy as all hell. Especially around this time of year. I don't know the rules for you particular insurance company but for mine when a member or provider requests an urgent prior auth we ask them a few questions first. Is the patient's life in jeopardy if they don't have whatever they are requesting done urgent? Can they go to the ER? If there life isn't on the line we then ask if they are in unbearable pain. If either one is a yes we process all urgent within 72 hours. Some stuff we have to process same day like chemo treatments and fertility procedures. We don't fight the provider or patient's usually. If they answer yes to the questions we take their word for it.

My doctor's office told me this as well; that insurance providers are busier around this time of year. My surgery was submitted in mid-November and I was approved in four days (I have BCBS). I was expecting two weeks, which is what I was told was the average. I hope that you hear back sooner than that!

[TXMom*3 7]

Thanks for the reply yall!

Im sooo nervous!

This Morning the Dr called to change to "Urgent"....I called back around 4 and she said its in "Final Review" and ill get an Answer in 2-3days, or maybe tomrrw!!!

O.M.G....Ughhh, I'm So Flippin' Nervous, Scared, and Excited!!!!

*Fingers Crossed* and Prayers for a Approval!! I Need this Life Change!

[LadySin 404]

You'll probably have an answer tomorrow if you call back. We don't like to leave urgent sitting at all. That's when the government auditors (CMS) starts really riding our asses. Their the reason we've got no more than 14 days to complete standard prior auths requests.

Edited December 6, 2018 by LadySin
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[Mom_of_Chaos 545]

On 12/5/2018 at 10:50 PM, TXMom*3 said:

Thanks for the reply yall!

Im sooo nervous!

This Morning the Dr called to change to "Urgent"....I called back around 4 and she said its in "Final Review" and ill get an Answer in 2-3days, or maybe tomrrw!!!

O.M.G....Ughhh, I'm So Flippin' Nervous, Scared, and Excited!!!!

*Fingers Crossed* and Prayers for a Approval!! I Need this Life Change!

Did you end up getting your approval?

[vovo2013 35]

Cigna approve me in 4 days. It was not urgent since my surgeon did not have any dates until Aug 2019.

Sent from my SM-G973U using BariatricPal mobile app

[Mom_of_Chaos 545]

Awesome!