At my wits end with my surgeon...Suggestions?

I have jumped thru the Insurance hoops (BCBS) and supplied all the required data to the surgeons office April 16.  I followed up in May only to learn they had just submitted my request on May 14.  Okay, change in staff... it happens.  I follow up every 2 weeks with them for the first 6 weeks and now I call / email twice a week just trying to get an update but no response.  Its exasperating but I do / did have confidence in the surgeon.  Am I just impatient or start shopping for a different doctor?  Open to any suggestions from your experiences.  Thanks for reading.

If you have confidence in the doctor. I would ask for a meeting with the office manager and go in. Sit down, look that person in the eye and see what is going on. Be honest and say you are considering another surgeon at this point given the delays. See where it gets you.

A doctor has very little knowledge of their offices insurance approval stuff. At least that is how it has always been for me.

Have you tried calling your insurance company and seeing what they say the status is? If it is stuck in their red tape there is nothing the office can do. While it is frustrating, it is not their fault... On the other hand you will find out if they really submitted it May 14th. Just an idea.

Yes, call your insurance company and see what they say.  Good Luck and keep us posted

Please call your insurance company today.  Ask for a supervisor!  You don't need one, but asking for one will get someone's attention real quick-like.  You can let them know that you're calling because you're excited and anxious to hear, and appreciate their taking the time to check for you.  I work in health insurance and get calls like that all the time. 

If there is an issue (like missing documentation), please make sure that you repeat back what the representative tells you to confirm exactly what's needed.  Then call your surgeon's office back or go to the office in person.  There's definitely something goin' on. 

Please let us know!  Good luck to you.

Sandie

I have a fantastic pre-Authorization coordinator I am working with at my surgeon's office. I asked her about the wait time once I am submitted and she said "Once I submit the case Anthem BCBS has 15 business day to get back to us with a response, in some case they do get back to us sooner than the 15 business day."

I think if they actually submitted your authorization in MAY then in theory you should have a response by now. So sorry to hear you're at your wits end because of this. I would be dying to know myself!

You say that you are following up-- with the insurance company? Or the surgeon's office?

Call your insurance company and ask them if they've submitted your paperwork for review. You need a firm answer on when, if at all, your file was received by BCBS. Usually they take no longer than 15 business days to make a decision. Ask if they can provide a status-- usually they can give you approved/denied/further review status.

Then call the surgeon's office. Stop by in person if you need to. Ask to speak to the office manager/supervisor. Let them know that there's been a problem with your insurance approval. Ask them to pull out your file, and see if they have a record of things being mailed-- copies of faxes, electronic receipts, phone memos, that sort of thing.

I'm guessing there are a few possibilities here:

• BCBS still doesn't have your file
• BCBS did get your file, but needs more info and is waiting on the surgeon's office
• BCBS denied the claim and your surgeon's office didn't inform you

Between the two offices, you should figure out what exactly your claim status is, then go from there to figure out how to advance. Unfortunate that we have to do some of the legwork, but worth it in the end!

Have you called the insurance company to see if you've been approved?  They should be able to tell you that...or if they even received the paperwork.  Go that route instead.

To all the Great people on this site....THANK YOU for the replies and help.  I got a firm answer from the insurance company after waiting an awaiting for a supervisor that all was in order.  And then....the surgeons office called today with Great news...... I got my DATE.    What a relief.  No nervousness or anxiety, only a rush of good feelings and energy. 

Thank you all for taking the time to respond and basically, making me get mad about it all and making something happen.  On my way....

Right on! Such great news. Good luck to you.

Robin