How long did you wait for your approval?

[4jin 0]

Because insurance companies love it when you have something missing ....gives them a reason to deny or pend for a longer period of time and hope you'll get tired of the wait or having to wait even longer and not continue to pursue.

They are evil even if they end up approving you....they are evil.....

EnchantedRuby,

hang in there I am still waiting too....

[EnchantedRuby 0]

I've been approved!!!!

Calling everyday paid off.. the insurance rep said the approval letter was MAILED to Dr's office. Can you believe that?? That means I would have had to wait another 7 or so days to hear from the Dr's office that I was approved!..

Man I called the financial/billing person at the Dr's office, told her I was approved and she said "ok, let me call them directly and I'll call you right back"..

She called back congratulated me on my approval and said the coordinator will call to schedule the appointment..Guess what I said???

"That's ok.. if you can just transfer me now I'll talk to her directly".. hehe

Well the coordinator of course was not in but I left a message on the voicemail, and I'll call every day till I speak to her!!! ..hehe!!

I'm sooooo excited!!.. (doing the happy dance!!):smile:

[destiny79 0]

:smile: CONGRATS GOOD JOB !!!!!!!!

[kaninag 35]

Good For You!!!!

Congrats!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[4jin 0]

congrats!!!!!

[tweety63 0]

Well I recieved my second denial today,bummer I have bcbs hmo. Its the hmo dept. making excuses. First said I need to loose weight did that then said because bmi is 39 they wont approve. Get this I have RA high cholestrol pcos I dont know what else I have to do to get approved.

[tweety63 0]

I might need to get an lawyer involved.

[Frustrated 1]

I've been approved!!!!

Congratulations. Btw, I love your name. :ohmy::smash:

Just a note for anyone out there who is starting this process, I was told that at times if you're borderline for approval/denial, quite often they'll deny you. Those who really mean business and want this surgery desperately will go through the appeal process. Those who aren't so desperate will not. Stick with it!

For those making the daily calls, keep it up. Keep a log of your calls (who, date and time) so that when you get a good piece of information you can keep a record of it and if someone says something different you can respond with "I called and spoke with <name> on <date> at <time> and he said <message>. Believe me, the insurance companies have a record of each time you called and who spoke with you.

Now even after you get the golden approval letter, don't let up on your good record keeping. I started my process in January 2007 and after an initial denial was finally approved in June. My surgery date was July 26. In September I started getting statements from the hospital I had my surgery to say that the insurance company hadn't yet paid and there was an outstanding balance of over $7,000. I've had to make numerous calls between the hospital, my surgeon, and the insurance company trying to get things sorted out. My insurance company (BCBS California) at one point told me that I wasn't approved for this surgery. Thankfully I had my log at hand and could tell them exactly who I spoke with on the phone when I was approved after my initial denial, the date my approval was sent and the name of the insurance physician who approved me. They then wanted ME to send THEM a copy of the approval letter. I think this was yet another delay tactic. But I did exactly that. I sent them the info. Of course I was sent a letter about 10 days later saying it was under review and I'd hear back from them within 45 days. They're reviewing their own correspondence?

To make a long story not quite so long (too late, lol) I finally just 6 days ago got a letter to say that approved payment for the surgery they had already approved payment for.

This process really tests your nerves and stress levels. But if I had to go through the entire thing over again, I'd do it in a heartbeat because it was well worth it. Yes, definitely worth the buckets of tears shed over just getting to the operating table.

[Frustrated 1]

Well I recieved my second denial today,bummer I have bcbs hmo. Its the hmo dept. making excuses. First said I need to loose weight did that then said because bmi is 39 they wont approve. Get this I have RA high cholestrol pcos I dont know what else I have to do to get approved.

Tweety, this is one of the excuses I was given. My weight and BMI didn't fall into the acceptable category. Initially I had a BMI of 35.9 and it needed to be 36 with my co-morbidities. If I had no co-morbidities it had to be 40. So find out what's required without co-morbidities and see if you can attain that target. During the waiting process I gained more pounds but I was about 18 short of their target BMI. I actually got to speak to the person who denied my claim. I wasn't taking enough medication for my insulin resistance (pre-diabetes). I needed to be on 2 meds instead of the 1. PCOS didn't seem to make any difference. The results of my bloodwork wasn't "severe" enough to be life threatening.

In the end I said "So are you saying that in order to get this weight loss surgery what I have to do is get my BMI up to 40? In other words gain more weight?" He said "Yes, but you're never going to put that much weight on." And he had the nerve to chuckle! Well I accepted that challenge and 3 weeks later I was at the required BMI and went through the appeal process. Not a fun thing, but a necessary evil.

I just found it insane that I had to gain weight in order to be able to lose weight. It may sound like a dream needing to eat anything and everything I could to gain this weight on but I never felt worse in my life. I was so worried I'd still be denied and I'd have these extra pounds to carry around.

But all the insurance nightmares are behind me now. *touch wood*

Hang in there and be persistent. If this is what you really need, don't let go of that goal.

[4jin 0]

Well I recieved my second denial today,bummer I have bcbs hmo. Its the hmo dept. making excuses. First said I need to loose weight did that then said because bmi is 39 they wont approve. Get this I have RA high cholestrol pcos I dont know what else I have to do to get approved.

I am so sorry to hear that tweety.

Yes I would definitely get an appeal attorney to do all the work for you.

Between us...I gained weight as well. I have no comorbidities, but I knew unless I had the 40+ bmi I was going to see denial.

I think that's why its been almost 30 days and I have not heard a decision yet....

but I gained did a bit too well I have to say...and my bmi is 41.5 at the time of consultation. I am back down some-so If I get denied I will have to get back to gaining and probably go past the 41.5 bmi. oh...I also had the doctor office take my height wrong...i uh...seemed to shrink an inch at the consult...(just bent my knees)

cry it out...let it out....then arm yourself...you can win!!

[abeaher 0]

Back to the initial post....By law insurance companies have 30 days to review a claim and give an answer. So whatever time of year, holidays or not, reps on vacation or not, you waited WAY to long for your answer. I would have threatened to take legal action. But none the less, good for you on your persistance! I hope it pays off for you!

Abeaher

[4jin 0]

Back to the initial post....By law insurance companies have 30 days to review a claim and give an answer. So whatever time of year, holidays or not, reps on vacation or not, you waited WAY to long for your answer. I would have threatened to take legal action. But none the less, good for you on your persistance! I hope it pays off for you!

Abeaher

do you know where I can look that law up. I need to know if I am calculating 30 calendar days or 30 business days.

[ForwardLeap 0]

I had BCBS of Kansas-blue care. I had my approval within 1 week and surgery scheduled 2 weeks out!

Wishing you the best,

Christie

[Frustrated 1]

do you know where I can look that law up. I need to know if I am calculating 30 calendar days or 30 business days.

If you have a letter from your insurance company it should state in there both your and their rights. They have to let you know what those are. You should also be told how to appeal and what actions you can take if you disagree with their findings. It should also state what their requirements are as far as response time is. Take a look at some of your recent correspondence from them to see if it's there.

[4jin 0]

That's it online the prior approval request is not posted...if I call regular customer service...they can't see in the system because prior approval uses a different database. To get prior approval on the phone is a hassle...hang up..call back..hang up..call back...until someone finally answers.

I have never received a letter recognizing they have received my paperwork...and that my request has been pending.

I have documented all the calls, who I spoke with..and what the messages have been...

well I called the Georgia Insurance commission and was told 30 calendar days is their mandated response time in writing...they haven't done that...guess what ...i called the supv back...she picked up the phone...she informed me sent my record to urgent RN reviewer and should hear back decision in a couple of hours. But will call me back today and verified my call back number.

But I do want to arm myself with as much info(which is my ammunition) as possible.!!!

Thanks for your info I had not even realized I have never received anything from them in writing....hehe..