Question:
Hounding the insurance company
I have made the request for the WLS to my insurance through the WL Surgeon. The surgeon received my paperwork 2 weeks ago and submitted my claim to the insurance which has had the claim for a week now. Who do I hound to keep on top of this, the insurance company or the doctors office? I kept being told to stay on top of my claim but I'm not sure who I should be contacting. — Kaychell (posted on May 6, 2007)
May 6, 2007
I was told they had up to two months to make a decision hounding did not
make a difference.I dont want to be negative,but it took me two years to
get approved for lapband.If you get denied dont give up,I finnally won.I
had surgery march 15.Sandy Hanson
— Sandy Hanson
May 6, 2007
It can take 4-6 weeks, be patient hon. Oh and call your doctor twice a week
to find out if they heard anything after waiting the 4th week.
Mickey.......
— MCraig3
May 6, 2007
You should be "houding" your insurance company. The surgeon's
office can't do anything about it. I was in medical billing for 12 years,
so sometimes it does help to stay on top of things and call your insurance.
Good luck!
— crystalsno
May 6, 2007
As long as your certain that your insurance company has your paperwork..
Hound them. You can make a polite call to the authorization dept. Just
making sure they don't need any further info. All the while checking the
status.
I was very lucky. My paperwork was submitted on a wed and i was approved by
friday.
See if they wil tell you the max amout of time thiis can drag out. They
normally have a policy on authorization turn around.
Good Luck to you,
Michele
— michelemcd
May 6, 2007
What happened with me was my insurance company sent me a letter advising
they couldn't rule on the request because they needed medical information
from my surgeon. Well I called my surgeons office and they had faxed the
information -- they must have or else I wouldn't have recv'd the letter.
And then they needed a letter of notification from my personal physician --
this was to indicate that she was aware that I was pursuing the surgery.
When I contacted the surgeons office she contact my PCP and she faxed my
surgeon the letter within 24 hours and the surgeons office had a contact
name at the insurance company and faxed the information directly to that
person -- I had a decision in 2 days -- so in all it took about 2 weeks.
Some insurance companies just drag their feet -- like its THEIR money they
are spending. I'd call the insurance company to make sure they recv'd the
paperwork -- faxes aren't 100%
— the7thdean
May 6, 2007
You can make polite inquiries to both the surgeon's office to see if they
have heard anything and also the insurance company to "check the
status of the approval" I would do this once weekly. Good luck to
you. As you can see there is a lot of disparity regarding how fast you can
be approved. Mine took about 4 wks to be approved and then had to wait for
a surgery date. Good luck to you. Keep on your preop diet and change
those habits for the good.
— Kari_K
May 6, 2007
Some offices are so busy, you absolutely must keep checking in. I would
call your insurance to see if they got the claim, if not then you can call
your doctors office to say that the insurace has not rec'd the claim. In
my case, the doctors office told me they submitted, but really they had
not. (maybe the fax did not go through) I waited a few days and then
called my insurance who informed me they did not have the claim. At least
when I called back, I could tell the office staff that my insurance did not
have anything yet. I agree with previous posts that being pleasant is in
your best interest.
— robinmarra
May 7, 2007
Keep checking with your insurance company. I would wait at least 10 days
before calling again. They can tell you if it was sent in for review or if
it has been approved. It takes a little longer for you to get the letter
but they can tell on the computer faster if it has been approved or if they
need something else from you.
— Virginia M.
May 7, 2007
Hi Kayla, thanks for writing. You should stay on top of your claim. First
of all though, please don't "hound" anyone. You will always get
more bees with honey than lemon. The only thing you need to do is call
your insurance company. The phone number should be on your insurance card.
When you get to the insurance reps that answer, then ask them. Tell them
that your surgeon has applied with your company for wls on your behalf.
You would like to know if the paperwork is in the system, can they tell you
please? Once they confirm that, then ask them at which stage in the
process is it, and how long does it take for approval. Always assume that
you will be approved. Once they answer your questions, be sure and thank
them for their answer and tell them goody bye. Then in a few days,
probably 3, call them back again and ask how the review is going. Wait for
3 more days and then do the same thing. Keep that up until you get your
answer. Once you get your approval verified by phone, call your surgeon
and telll them that you received word that you had approval from your
company and you want to set a date. Again, being pleasant will help both
you and the other party on the other end of the phone. If you get a
denial, then you need to find out why from your insurance company and try
to rectify the problem. It may be that you need to meet a requirement or
that there is something missing from your file. Once you get them the
information or fill the requirement you can ask for a review and go again.
Be patient and kind, and others will work with you. Be tough if you have
to, but make it a last resort. Take care, Patricia P.
— Patricia P
May 7, 2007
My doctors office told me it could take a month for the insurance company
to respond. I was lucky, it only took my company a week. I would at least
give it a month then maybe contact your doctors office.
— barfiep01
May 7, 2007
I disagree with a previous poster. Being nice, 99% of the time get's you
delay's. Endless, needless delays. Most insurance companies don't like
covering this surgery because it is quite expensive. As far as hounding,
let me explain that a bit better. Call them every few days, but be FIRM
with nice undertones. Let them know that you will be calling back every
few days to check up on things and to make sure they have everything they
need. If anything is needed from the surgeon's office, offer to get that
for them as some surgeon's offices are quite busy, but be FIRM and clear
about your intentions on staying on top of this to get it through the
system as soon as possible. Good luck!
— crystalsno
May 7, 2007
Sorry, forgot to state this. Most surgeon's offices, need a LETTER of
approval, not just a voice confirmed, over the phone approval. Your
insurance company should send you this letter, often times you will get it
before the surgeon's office. As soon as you get your letter, fax it to
your surgeon's office and request a date. Good luck!
— crystalsno
May 7, 2007
Sorry, forgot to state this. Most surgeon's offices, need a LETTER of
approval, not just a voice confirmed, over the phone approval. Your
insurance company should send you this letter, often times you will get it
before the surgeon's office. As soon as you get your letter, fax it to
your surgeon's office and request a date. Good luck!
— crystalsno
May 9, 2007
first who is your ins. i can give you advice for what i did to get a
proved. Before wls i was going to a doctor to help me loose weight so i
brought my medica record s in . once i showed proof that i tried to loose
ot on my on they aproved it instantly. i say run up there bill seeing a
dr. for weight loss . keep complaning. thats how you expedite matters
promptly
— yvettetas
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