Question:
Anyone with BC/BS PPO of GA have any trouble getting approved.
My letter was received by them on April 3rd. The rep said that it can take up to 14 days for an answer. I am just so anxious to get approved. My BMI is 42 and the only co-morbities I have are back pain, knee pain, and shortness of breath. I'd appreiciate any other experiences with them. Thanks — mikawill (posted on April 5, 2002)
April 5, 2002
I have BC/BS POS of GA. I had problems with them initially receiving my
approval letter. It took about a month before they put the information
into the system. The only way that I could confirm that they received the
info was thru my Dr's office. Then after about another six weeks, they
came back and requested a psch eval, nutrionist eval, and clearance from my
PCP for major surgery. I was advised that this now mandatory for
everyone. I hope this helps. GOOD LUCK!
— lturman
April 5, 2002
Tonya,
Thanks for your input. I too had problems at first with them receiving my
letter. Dr. Smith's office mailed the letter off on 3/20/02. They mailed me
a copy the same day. I received my copy on 3/23/02, so I called BC to see
if they had gotten anything and they said no. I called again a couple of
days later and still NO. A rep gave me a fax# to use, so they faxed a copy.
I waited a couple of days to call, now they have'nt received the fax. Dr.'s
office faxed it again. After talking to about a million different people I
finally talked to someone who was so nice and personally helped me. I
explained my situation and she personally walked over to the fax machine to
check. She said she found it and it was the last one in the pile. I guess
persistence pays off. I just hope it gets me approved. I'll check again
next week. Keep your fingers crossed for me. I have already had a psych
evauluation and pulmonology test. PPO doesn't require a referral and my Dr.
said I didn't need a cardiology test. Its weird how BC/BS has so many
different kinds of policies that are so different from each other. Thanks
again.
— mikawill
April 5, 2002
I have BCBS PPO of Ohio though....it's Anthem. My best advice that I can
give you is to be persistant. If they finally say that they received your
information, call back and specifically ask if it has been taken to the
medical review board yet (sometimes it will just sit on their desks). If
you didn't submit a psych eval, or the nutritional eval, you will get a
response saying that they need thoughs--however, they won't call you...in
about a week or so they MIGHT send out a letter, so be dilligent with your
phone calls. And make sure when you talk to them, try to make them be as
SPECIFIC as possible with regard to what else they need. Case and point-
they came back and asked for the two above mentioned things...but to them,
a nutrition evaluation was a diet history (a more elaborate diet history),
and a letter from a previous/current PCP saying that you have in fact tried
this, this, this, and this. I have talked to the ins. company so many
times that I know who to talk to to get a straight answer...find that
person in your ins. company, and request them...if they say that they can't
transfer you (which is a load of ****), hang up, and call back and find
someone who will. Pleae be pro-active with them...your doc's office has
hundreds of other patients they are also dealing with...not just you! I
wish you all the luck, and I really pray that you don't have to go through
the same hassles that I am going through! My best-
— Sarah P.
April 5, 2002
Sarah,
Thanks for your response. I am going to continue to be persistant. If I
hadn't been I know I would still be assuming they had received the letter
when I received the copy. I'll have to call them and make sure they have
everything they need. The last rep I talked to gave me the direct number to
call to check the status of my "prior apporoval" request. That's
what she said it was called when you are requesting approval for gastric
bypass. She said that "pre-certification" was different even
though to me they sound about the same.I'll keep you posted. Thanks again
— mikawill
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