New to site-Waiting on approval

[ws467 0]

:rolleyes2:I'm new to this site and am in the process of awaiting approval. I have insurance with Highmark BCBS. If approved for the surgery, I will be having it in Texarkana, Tx. I've been to ww for 7 months, 5 yrs of doctors records, 2 sleep test and waiting to be fitted for a cpap. I have also had 1 visit for a mental evaluation and 1 with a nutritionist. I'm a teacher so I'm hoping to be able to have the surgery before school starts. Does anyone have this particular type of BCBS?

[nursenky9 0]

Hi WS, I live in KY and have Highmark of PA. I work for a hospital chain. My surgeon sent my info to the ins on July 3. The ins. told the surgeon's office it could be as little as 48 h (not that lucky) up to 6wks for pre cert or pre determination.

I went on line to their website and downloaded their booklet and it said that for precert they will notify in writing within 15 days of their receiving the info of their decision.

I have all the supervised wt loss info exercise log psych eval and nutritional consult.

Hopefully we will both hear some positive news soon. Let me know.

[tkcnavy 0]

I am new to this- my first post! Had my orientation on June 11, first visit with Dr on July 22. Does anyone have experience with TRICARE? Just wondering how long to expect approval etc. Looking forward to a reply! Thanks!!!

[dwrd73 0]

I'm also a teacher and hoping to get banded before school starts. My paperwork was submitted on last Friday. I will be calling BCBS tomorrow to make sure the received it. The doctor's office said it usually only takes a few days for approval. I'm hoping they are correct.

[tkcnavy 0]

I taught school for many years before going to nursing school at 45. Right now, I am waiting to move (next Feb or sooner) wth my husband- who is active duty Navy to get a job. I thought this period of unemployment would be a good time to do this.

I was very discouraged about the period between orientation and getting to actually see the Dr. This group acts as if they are doing you a favor. Oh, well-I know it will be worth it !! Hope you have enough time to have the procedure befre school starts!!!

[ws467 0]

Thanks for the insurance info. I think my dr's office stays pretty busy and they want to make sure that you have everything before they seek approval. I hope that they send mine in this week but I don't know. I will let you know when I hear something.

[ws467 0]

Do you also have the Highmark BCBS?

[MsNeka 0]

Hi, I have TriCare and it only took a wk for approval. I'm currently waiting on a surgery date. Good luck...wishing you well.

[htaylor1021 0]

I have Highmark bc/bs ppo also. I was only required to do 6 months of supervised meetings. I just had my lost visit with the psych and nutritionist on Friday. I don't know if they submitted the paper work friday or if they would wait until Monday. WS467 have u heard anything back yet? Nursenky9, I have been following your trials among the threads. What happens now that they have refused to accept some of the stuff you submitted. Please keep me updated. I will be sure to do the same too.

I am Heather btw. I live in CT. I am a peditatric home care nurse. Married 1 DD. (2 if u count DH)

[crome 1]

took me until 4:45 the day before surgery to get approval, apparently this is normal and the doctors office is aware of how it all works....

[dwrd73 0]

I have BC/BS as well and I kept calling to make sure they received all the information. It took a few days before everything got into their system but once it did I was approved. I knew before my doctor's office. I told them. Overall my doctor submitted the paperwork on a Friday and I was approved by Tuesday. Surgery is scheduled for 8/25. I wish it was sooner b/c I am a teacher as well. Students come the following week on 9/02. I hope to have everything reading in my classroom post op so I can just walk in on the 9/02 and teach. I will miss the first day for teachers. Oh well, just a bunch of meetings.

[htaylor1021 0]

I am APPROVED!! They sent in my paper work on Teusday I had my Approval by Friday and Surgery is scheduled for next week 8/13/08

[pmcfarm 0]

tkcnavy...I also am Tricare. I think it depends a lot on how your PCM and surgeons office prepare the necessary documentation. I had a seminar & 1st appt. with surgeon within 2 wks. after my PCM sent the referral request. My Tricare approval took only 6 days. My surgery is scheduled Sept.30th (his earliest appt). I think it also may involve your co-morbidities & their severity. Here's praying for a faster process.

[nursenky9 0]

Have u heard anything from Highmark yet?

I just found out today that Highmark denied my surgery. Good luck!!

I will talk with the surgeon on Monday to see what is going on. The ins co told me that it wasn't medically necessary, they did not have the medical records such as the psych eval nutrition, and supervised wt loss. I had 7 months of supervised WL.

Best of Luck!!

[ws467 0]

No, I have not heard anything yet. The drs office didn't submit my paperwork until July 31 and when I called the ins co they said that they have 30 days to decide. I'm afraid that they will not approve even though I have everything done. This is beginning to be quite frustrating! Someone emailed this week that is using the doc that I am but they are self pay-they went on July 28 and started 2 wk diet on 8/8 and will be operated on 8/22. If I were wealthy I guess I would have a date.

ws467