Waiting for Approval

[4jin 0]

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Thanks, You won't believe this <img src="http://www.LapBandTalk.com/images/smilies/faint.gif" border="0" alt="" title="Faint" smilieid="236" class="inlineimg" />My insurance company changed names on Jan 1. They lost my paperwork in the switch. <img src="http://www.LapBandTalk.com/images/smilies/mad.gif" border="0" alt="" title="Mad" smilieid="9" class="inlineimg" /><img src="http://www.LapBandTalk.com/images/smilies/mad.gif" border="0" alt="" title="Mad" smilieid="9" class="inlineimg" /><img src="http://www.LapBandTalk.com/images/smilies/mad.gif" border="0" alt="" title="Mad" smilieid="9" class="inlineimg" /> There is no record that I was approved and we have to start over at square one. She said she did make it "high priority" this time. <img src="http://www.LapBandTalk.com/images/smilies/speechless.gif" border="0" alt="" title="speechless" smilieid="45" class="inlineimg" /> I just want to cry but I can't because I am at work. <img src="http://www.LapBandTalk.com/images/smilies/depressed.gif" border="0" alt="" title="cry" smilieid="49" class="inlineimg" />

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NO FLIPPIN' WAY!!!

No..... Call them back and you tell them it is nor your concern nor problem that these changes occurred. If paperwork has been misplaced it is in their best interest to locate it. It is highly confidential personal medical records part of HIPPA law-it requires them to safeguard record keeping documents. By admitting to you it has been misplaced they are violating the law. Let them know you will proceed accordingly. Give them x # of days to find the paperwork, and report this to your HR benefits coordinator ASAP. This sounds like a major problem that needs addressed immediately!

oh

....I am sooo..sorry to hear that...but it is time to take a stand and show them you are not afraid and will not be taken advantage of. Now...I am not saying be mean, nasty or rude...just be polite by all means..that is the key....just be firm & passive aggressive..(so they know you will not just go away).....you should not be tossed around like a hot potatoe and you are determined to find out whose hands dropped it!

in the meantime....vent ...vent..here...

[AmyMT 0]

I just talked to my insurance AGAIN. This time they told me the decision is another week out. Arrrggghhhh!! I explained that in order to keep the date the doctor has me scheduled, I need to start the 2 week liquid diet no later than Tuesday, the 8th. So the guy I was talking to went back and talked to the examiner again and then told me that the examiner will call me either Monday or Tuesday to let me know something. If there is no decision yet then she will let me know how she "thinks" it is leaning. I am still shaking.... I really feel like I am getting the run around. But I suppose a positive spin on this would be that if I didn't meet their basic criteria they would have denied me immediately and gotten me out of their hair.

:gluck: to everyone else still waiting.

~Amy

[StLouisGal 1]

I just talked to my insurance AGAIN. This time they told me the decision is another week out. Arrrggghhhh!! I explained that in order to keep the date the doctor has me scheduled, I need to start the 2 week liquid diet no later than Tuesday, the 8th. So the guy I was talking to went back and talked to the examiner again and then told me that the examiner will call me either Monday or Tuesday to let me know something. If there is no decision yet then she will let me know how she "thinks" it is leaning. I am still shaking.... I really feel like I am getting the run around. But I suppose a positive spin on this would be that if I didn't meet their basic criteria they would have denied me immediately and gotten me out of their hair.

:gluck: to everyone else still waiting.

~Amy

Not only do you and I have the same ticker, we seem to have the same luck with insurance companies. I am on hold with mine again. Still no word. They will call me when they know something. :hurt

Hang in there! :cheer2: I'll try to also. Eventually someone has to listen.

Mine has an automated system that you have to get through before they will let you talk to a real person, then you have to sit on hold for 15-20 minutes. Boy, if I offered this type of customer service I'd get fired. :angry

[StLouisGal 1]

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NO FLIPPIN' WAY!!!

No..... Call them back and you tell them it is nor your concern nor problem that these changes occurred. If paperwork has been misplaced it is in their best interest to locate it. It is highly confidential personal medical records part of HIPPA law-it requires them to safeguard record keeping documents. By admitting to you it has been misplaced they are violating the law. Let them know you will proceed accordingly. Give them x # of days to find the paperwork, and report this to your HR benefits coordinator ASAP. This sounds like a major problem that needs addressed immediately!

oh

....I am sooo..sorry to hear that...but it is time to take a stand and show them you are not afraid and will not be taken advantage of. Now...I am not saying be mean, nasty or rude...just be polite by all means..that is the key....just be firm & passive aggressive..(so they know you will not just go away).....you should not be tossed around like a hot potatoe and you are determined to find out whose hands dropped it!

in the meantime....vent ...vent..here...

I called them again today. They repeated the same line of B... they gave me yesterday and told me to be patient that they are researching it and will call me when they find the answer. :hurt For crying out loud, that is now what I wanted to hear. I took her name and told her I would look forward to hearing from her. :angel: Then I picked up the phone and called the HR department of my husbands work. I talked to a nice person there who said she would look into it and call me on Monday. Hopefully she will have more pull that the folks administering my insurance. In the mean time I am bouncing off the walls.

:bounce::bounce::bounce::bounce::bounce:

[4jin 0]

Ok so I call my insurance company directly yet again...

got the run around and transferred and transferred and transferred and transferred...then the woman I spoke to could not find anything for me in the system...I gave her the name of the last person I spoke to...she said...i know who that is, but I don't see a record for you I said faxed on 12/17/07 I have called before and others have found it...I told her what type of surgery...Lapband...she then goes oh..that's why...hold on that type is somewhere else...transfer's me and I had to leave a voicemessage...

this time couldn't even speak to anyone...what is going on...I was nice...but my patience is drying thin.....

:angry:angry:mad:

[lkgrubb 0]

Ok so I call my insurance company directly yet again...

got the run around and transferred and transferred and transferred and transferred...then the woman I spoke to could not find anything for me in the system...I gave her the name of the last person I spoke to...she said...i know who that is, but I don't see a record for you I said faxed on 12/17/07 I have called before and others have found it...I told her what type of surgery...Lapband...she then goes oh..that's why...hold on that type is somewhere else...transfer's me and I had to leave a voicemessage...

this time couldn't even speak to anyone...what is going on...I was nice...but my patience is drying thin.....

:angry:angry:mad:

Can I ask which Insurance company you are dealing with?

Also which state you are located in.

Another suggestion is to ask your doctor to give you a copy of all that has been provided to insurance. I found several mistakes and the fact that some information did not follow my insurances guidelines. It did take several months to clear up the mistakes and get my application back on track.

[AmyMT 0]

:hug: 4jin. I so understand what you are feeling.:frusty: Hopefully we will all have very good news very soon. :pray:

~Amy

[StLouisGal 1]

:hug: 4jin. I so understand what you are feeling.:frusty: Hopefully we will all have very good news very soon. :pray:

~Amy

Amen to that. :amen: Count me in your prayers too. :pray: I'm in the same very frustrated boat as the two of you.

[4jin 0]

AmyMT, StLouisGal...

thanks so much guys!!!!

yes group huggggsssss

And I will keep you guys in my prayers.

[4jin 0]

UPDATE!!! Might be a long post...sorry

Ok so I called the insurance company back yesterday about 2 more times..each time...lots of transfers...and ended up in the same spot...an answering machine everyone assisting other customers.....

did some online searching last night...found the prior approval tel number for georgia...called it this morning...lines busy....

called the other number I was previously calling....no luck....rep didn't even attempt to listen to me....asked me same question 3 times and differrent times on the call...:rofl: finished with her...."no there is no phone number for the prior approval dept" she said...

ha!!!

I refused to give in today....very fustrated in a private office at work....I was venting alone...:angry:angry

Decided you know what....I am going to be passive aggressive..

called back the number I found on the internet last night....

spoke to a rep who was lots of help (but everyone kept putting me on hold)(had the feeling something was there that they did not want to say) but I held....kind of joked with her and thanked her for being the first person to listen...she transferred me to a live person in prior approval....I was flabbergasted.....OMG:omg:

The rep I spoke to was very helpful....she said call back this FRIDAY....ouch..... I am praying ..praying every chance I get from now to Friday.....

She mentioned get this....my psych eval looked to be the hold up....

the psychologist did not put his license number in the report and he is not found as a licensed practitioner...say what!!!!

BCBS behavioral services approved him as in-network and covered the eval....so I look at my copies...and there it is NOT there his flippin' license number DARN!!! How am I suppose to look at that....But she told me not to worry she will be calling the psychologists office and my doctors office herself to get things clarified. Other than that nothing else noted.

I am so mad right now....my surgeon's office suggested that flippin' psychologist in the packet they provide to everyone...can you imagine how many people are probably having problems....errrrggggghhh,.

what should I do...should I go do another psych eval?

aaawwwwaawww

[lkgrubb 0]

UPDATE!!! Might be a long post...sorry

Ok so I called the insurance company back yesterday about 2 more times..each time...lots of transfers...and ended up in the same spot...an answering machine everyone assisting other customers.....

did some online searching last night...found the prior approval tel number for georgia...called it this morning...lines busy....

called the other number I was previously calling....no luck....rep didn't even attempt to listen to me....asked me same question 3 times and differrent times on the call...:rofl: finished with her...."no there is no phone number for the prior approval dept" she said...

ha!!!

I refused to give in today....very fustrated in a private office at work....I was venting alone...:angry:angry

Decided you know what....I am going to be passive aggressive..

called back the number I found on the internet last night....

spoke to a rep who was lots of help (but everyone kept putting me on hold)(had the feeling something was there that they did not want to say) but I held....kind of joked with her and thanked her for being the first person to listen...she transferred me to a live person in prior approval....I was flabbergasted.....OMG:omg:

The rep I spoke to was very helpful....she said call back this FRIDAY....ouch..... I am praying ..praying every chance I get from now to Friday.....

She mentioned get this....my psych eval looked to be the hold up....

the psychologist did not put his license number in the report and he is not found as a licensed practitioner...say what!!!!

BCBS behavioral services approved him as in-network and covered the eval....so I look at my copies...and there it is NOT there his flippin' license number DARN!!! How am I suppose to look at that....But she told me not to worry she will be calling the psychologists office and my doctors office herself to get things clarified. Other than that nothing else noted.

I am so mad right now....my surgeon's office suggested that flippin' psychologist in the packet they provide to everyone...can you imagine how many people are probably having problems....errrrggggghhh,.

what should I do...should I go do another psych eval?

aaawwwwaawww

I thought it might be something like this, Thank God you perservered. I can feel your frustration and also your need to know. We will all be rooting for you to get the answer by Friday. At least now you have a number and a name to call at Insurance .

Hang in there it will HAPPEN!

[StLouisGal 1]

:whoo:Hang in there, we are all behind you.:whoo:

:update:I spent considerable time on the phone on my insurance issue this morning. Talked to the HR lady who gave me an approval number (a letter was not generated) so I called the new insurance lady, gave her the approval number, she said that doesn't help because it is the approval number for the old insurance :rofl:(Note this is the same insurance company I have had for 20 years but they changed their name and customer service people) She transfered me to the lady at the old place who says she has requested the letter twice and they haven't sent it yet. :hurt They all want to know when my surgery is scheduled. There in lies the problem, can't schedule surgery or even pre-op until insurance approval. :rolleyes

I am so tired:tired of telling the same people the same story over and over again. :cry

[4jin 0]

I don't want to say it but.....everyone cover your ears..

StLouisGal...you must lie...no other option....give them a date...tell them your surgeon needs to have the approval in the file, hospital surgery date is set....just pick a date..I would say...10-14 days from now...I go for it...call her back...say it is scheduled for January 2X, 2008. OR is reserved and everything is set. Clear liquid diet starts on January 2X,2008 to clear me for surgery.

Lets play their hardball chess game.... check....your move insurance...

then when you hang up we both need the next morning to fast in order to ask for forgiveness from GOD for the lie.

[StLouisGal 1]

I was thinking the same thing but since I have been talking to the same person over and over, I can't change my story now. I'm going to let the HR lady be mean. She is going to call their supervisor and ask for the letter.

[StLouisGal 1]

We really shouldn't have to fight so hard for benefits we are paying for.