Question:
Has anyone had problems with insurance company asking for too much information?
I have Empire Blue Choice PPO. I have some co-morbidities and an extensive weight loss history. My Dr. submitted info to insurance company and than scheduled tentative surgery date. Now insurance company is requesting diet history, psych evaluation, documentation of co-morbidities etc. Isn't this asking a little to much. I feel as though they're doubting me and am having panic attacks in the process. The Dr's nurse said this is the first time she has had an insurance company ask for so much info. I am very anxious and having panic attacks that they will deny me. I have high blood pressure, high cholesterol and my BMI is 52.8. What are my chances of approval? does anyone have any advice or words of encouragement? — Jodie R. (posted on October 23, 1999)
October 23, 1999
When I went through the process, I too had to give the insurance company
all kinds of info. I had to have a psych eval, list and documentation of
diet history, plus when submitting for pre authorization they also wanted
to know about co-morbids. I was approved, it took about a month. I know it
is difficult for you at this time and can very much understand and relate.
Keep in mind the reason you are doing this, it is for you, and one way or
another you will get this done. Just need to have trust and faith. It may
be hard work, but take a deep breath relax and give them all they want.
Besides... most of the co-morbids will be disappearing after having
surgery, and the psych eval, well we know you are sane and why you desire
this surgery, so your ok there, and diet history, well that is just showing
them all that you have done to lose the weight and haven't been successful.
You will be successful, think positive, and move forward.
— Becki M.
October 23, 1999
I have Empire BCBS PPO also through my employer and I just got approved
last week. I think they are just going through the standard procedure.
You can always talk to your case manager if you have questions.
— Toni K.
October 23, 1999
I have found that it's not too much information to be asked for. The more
you can document the co-morbidities, the better chance for approval. Same
with a formal diet history, written out and covering all diets; seeing it
in black and white makes an entry into your medical record. Get all repots
of sleep studies, blood work, etc. and give them to the doctor to send in
(don't send them yourself) If you've been treated by a psychiatrist or
therapist, ask the to write a letter telling how medically necessary this
surgery and document your state of mind and willingness to understand and
accept this surgery. Your chances of approval are very good but we all know
that some insurance companies won't cover surgery even if you're on your
deathbed. Hang in there and get busy!! Staying busy also helps keep your
mind off the problem and focused on the solution!!AMEN!
— Fran B.
October 23, 1999
I understand your situation and anxiety--I have a very TOUGH
insurance company (GREAT WEST PPO) and I have had to go into the
"attack and fight" mode of thinking with them. Try to prepare
mentally that you might have to fight! BE SURE you have a surgeon's office
that knows how to "work" the insurance requirements--I had all
your company is asking for and 3+ years of continuous, doctor supervised
weight loss attempts. Make sure you are referred to a psychologist or
psychiatrist who is FAMILIAR with what the insurance wants--same goes for
the nutritional eval, etc, etc. Don't be afraid to talk to the insurance
company YOURSELF for clarification of what they want. I have had to do much
of the work myself, but it has helped me feel stronger and more determined.
Email if I can help you further. YOU CAN DO IT!!
— Julie H.
October 23, 1999
Don't worry I had to go through the same thing and it will all be fine .
The psych evaluation worried me the most but it was not bad at all. I am
one year out now and down almost 200 pounds . Good luck and don't give up
for it will be ok. Remember it just the Insurance way to stall.
— Patricia B.
October 23, 1999
Jodie: Don't worry, I too was asked for all that info. Actually, the more
co-morbidities the better the chances of approval. You should be accepted.
Good luck!!
— Dot W.
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