Question:
How soon is to soon to call for status of insurance approval
Ok a little about me. I started this WLS journey several years ago but kept getting shot down as my employer refused to pay for WLS or any sort of weight management programs. Several years later, I am now with a different employer with better coverage so I started the process again by going to a seminar in late January. I was eager to get the process started so I filled out my application and sent it in early february. I was originally going to be part of a research study that was going to pay for my whole surgery, however the study got put on hold for a year so I decided to go the regular route instead. I finished all my testing early May and saw my surgeon almost 2 weeks ago to sign my consent forms so they can get the insurance approval portion of this process started. It will be 2 weeks tomorrow since I was in her office and since the approval process should have been started. I have BCBS of IL even though I live and work in Oregon. Our firm's headquarters are in Chicago so that is why I have an IL policy. Part of the insurance requirements are that I have to have those 6 months of supervised weight loss attempts, in the policy it clearly states that WW is a suitable supervised program so I submitted those records since I was doing WW on and off for the last few years. Ok so now for my question, how soon is to soon to start calling to get status? I am tempted to call this week only because during this waiting time the office advised me to come in to see the Nutritionist once a month just in case the insurance would not take the WW for the 6 month requirement. I have my 3rd montly appt with her on the 1st of July and was hoping to get my approval before then as it costs like 80-100 bucks for that half hour visit I have with her. My insurance has paid everything else to this point but they will not cover the nutritionist appts as they consider it "education" and for some reason they wont allow it. I am very optimistic that I will get approved but like I said I just want that approval before next week so I am not forced to shell out another 100 bucks. Is it to soon if I call them tomorrow to get status? I know they are very busy but I am growing impatient and want to get this ball rolling. I was hoping to get my surgery in July otherwise because of my job I will have to wait till mid October to have it. — jenbn (posted on June 23, 2008)
June 23, 2008
Girl go for it.!!!!!!
As my late Grandmother always said, """"KILL THEM WITH
KINDNESS"... That is what I did. Make friends with someone you can
contact on a one on one bases. If you do this that person wll works for you
and with you.
Vickie [email protected]
— purplepassion555
June 23, 2008
just remember the squeaky wheel gets the grease. I started call three days
after the sent in the paper work. I also have BSBC PPO. The way I see it,
it is they work for us. Call every day until you get an answer.
Best wishes, my date is set for Aug 4. If you get your approvel soon they
might be able to get you in next month.
— tinajohn
June 23, 2008
It is not too soon to call for a status. I waited about two weeks and then
called the insurance (BCBSNC) and it turned out they needed a little more
info which I was able to give over the phone and voila! two days later I
was approved. My surgery is scheduled for August 4, My Approval came
through on June 4th.
— ibeanniebe
June 23, 2008
wow, I have BCBSIL also and they DID cover the nutrition education class.
that's crazy. I'm familiar with having insurance from another state
because of my husband's insurance - you are right, the coverage is from
where the hq is. Sometimes the staff of the doctor/practice will have an
insurance person to help with the red tape. There is a person who helps
with insurance (gratis) here on the board, if I can find her profile I will
post it.
— Mary H.
June 24, 2008
Jennifer
You should be callling BC Bs once a week or so to find out statis.
— jackgowen
June 24, 2008
Jennifer - your employer has an insurance broker who gets paid VERY WELL to
manage the account on behalf of your employer. Call HR and find out who it
is - their name/number may also be listed in (see back cover) or around
your BCBS benefit booklet. If you can't find out who they are then tell HR
you need the name/number of the insurance broker that put your medical
package together with BCBS. Your broker should go to bat for you - you
shouldn't even have to talk with BCBS. If the brokerage firm tells you to
go to HR or to call BCBS yourself they are NOT doing their job. They are
your advocate - make them earn their money. Brokers carry a lot of clout
because they bring many of their clients (employers) to BCBS. I was a
broker for nearly 20 years and many employees just don't realize they have
this kind of access for help. Don't give up, make lots of noise, fight for
the outcome you want! Good luck, Jen Wilkin
— wilkin
June 24, 2008
UPDATE - so its been two weeks as of today since I last saw my surgeon. I
called and spoke to the insurance coordinator at the office and was told it
was submitted to BCBS of IL on the 12th. However she said she has not heard
anything back yet. Based on advice I got on my original question, I called
BCBS of IL directly to find out if they have received the package from my
surgeon's office and they said they have nothing in their system. I realize
that its reviewed in the order it was received, however you would think
they would at least make a note to your account that they received
something. I also asked specific questions regarding my policy and the
coverage of WLS. They said it is not excluded from the policy but reviewed
and approved based on the standard criteria that most surgeons tell you
about. Also they said that i needed some sort of certifciate of prior
coverage to put in my file to see that I had prior coverage before this
company. I had no problem obtaining that from Cigna but I called the
surgeon's office once again to make sure if I should even be sending this
as I did not want it to jinx my approval. I guess my insurance has some
sort of pre-existing condition exclusion thingie in the policy and the
period is 12 months so mine ends 9/3/08. Have any of you heard of that and
if so did it hurt your approval process at all? I hate dealing with the
insurance co so my suregon's office said they would call BCBS in the
morning because she thinks they should not be asking me for that prior
coverage info. I am totally confused and getting impatient.
— jenbn
June 24, 2008
Jennifer, your policy has a pre-existing condition clause which says any
condition that exitisted within 12 months of your effective date is not
covered under your new plan for 12 months UNLESS you can show you've had
continous coverage with another carrier - it's called portability. I would
definitely make sure they have the previous CIGNA information. Your
insurance broker should have made sure the new carrier (BCBS) gave you (and
all other employees) credit for the time you were on the old plan (CIGNA).
Make SURE this gets done or it will hold everything up. You have a good
chance of getting this covered if you have a BMI that's high enough with
other co-morbidity issues like...... sleep apnea, high BP, diabetes,
etc..... good luck and again - CONTACT YOUR EMPLOYERS INSURANCE BROKER.
Regards, Jen Wilkin
— wilkin
June 24, 2008
I'm not sure I know any of these answers, but I can tell you what I have
been told so far. I have BCBS Community Blue. I also have to have a
letter from my physician that states I have been on a
"supervised" weight loss program for 6 consecutive months, but
within a 4 year span. I called my surgeons office and the insurance
specialist working with me said it can be any diet. It does not have to be
a "professional" diet. I thought it had to be something like
Weight Watchers, which I did not want to spend extra money on to sign up.
She said my visits just has to be documented by my physician. I need to
see him once a month for 6 consecutive months to have diet and counseling
documented along with weight checks. As far as the nutritionist, I wonder
if a medial diagnosis attached to your visit such as diabetes, htn, or hich
cholesterol would get paid for?
— tammyoc
June 24, 2008
Call everyday until you get the answer you want and be very thankful, I had
BCBS of Florida and WLS was a plan exclusion and I paid EVERYTHING out of
pocket.
Having been a nurse who previously reviewed these surgical requests, you
can also request the actual name and direct extension of the nurse who is
assigned to your case.
Good luck,
Dawn Vickers, RN, BLC, CLC
— DawnVic
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