I have kept track of my entire timeline, from the time I initially contacted the surgeons until today when I was given a confirmed surgery date. I did delete the names out of this because names are not important, however I did leave their job titles. CSR stands for 'customer service representative.'
I am using Blue Cross Blue Shield of Florida (BCBS of FL), State Employee Plan. Thought this info may help someone else that is struggling with being patient or antsy about the progress. I was told by the surgeon initially that if I 'kept at it', I could potentially be done with all of my prerequisites for surgery in about 2 months time. That was an overstatement I think on their part, b/c I had to have a sleep study done which seemed like it took four forevers! On that note, just stay on top of it, keep calling, aggravate them if necessary; a squeaky wheel gets the grease!
FEB 1- Faxed information and certificate of completion of online information seminar to UF Shands Surgical Center.
FEB 6- Called UF to schedule an initial visit.
MAR 22- Monthly appt w/ my local PCP
MAR 28- Initial visit to Shands at 13:00hrs, met surgeon and got initial paperwork and directions from insurance specialist. Was told I would have to attend a nutritional seminar that spanned two separate days over two weeks.
Called scheduling on our way back home (4hrs away), initial Nutrition class scheduled for Apr 2, second class scheduled for Apr 11th. Reserved hotel room for each night before each class.
APR 2- Initial nutrition class at 08:00hrs. After class walked to Cardiac facility and got EKG done. Contacted local psychologist for an appointment for psychological evaluation.
APR 5- Called Radiology at UF and scheduled Upper GI Series for Apr 11th after Nutrition class.
APR 10- Worked 16hr overnight shift, went straight to local psychologist's office for psych eval at 08:15hrs. Went home, napped, and got up to pack and drive to Gainesville alone for the night.
APR 11- Attended final nutrition class. After class went to Radiology dept and had Upper GI done.
APR 13- Wrote to insurance specialist via MyChart messages about possibility of having a telehealth conference with the nutritionist instead of having to drive 4hrs there and 4hrs back for a 30min meeting. Also asked for a referral to a local sleep lab for required sleep study.
APR 16- Reply from insurance specialist in MyChart messages stating she was able to set me up with a telehealth visit, however they did not provide referrals for sleep study appointments, I would have to get with my own local PCP for that.
APR 19- Went to Quest Diagnostics, fasting, for bloodwork and H. pylori test. Waited 2 hours and was finally told they did not have my paperwork or authorizations to do any bloodwork. Had to leave to go to another appointment and could not argue with them, plus I had to have breakfast before the next 4 hour appointment.
APR 24- Monthly appt w/ PCP, got referral for sleep study at a sleep lab. Scheduled appointment online for Quest Diagnostics for the morning of Apr 26th.
APR 26- Went to Quest Diagnostics, fasting, and waited in waiting room for 3 hours. Get to desk and they tell me I do not have an appointment scheduled. I also do not have any paperwork or authorizations once again to have bloodwork and H. pylori test performed. I am fuming mad and stand at the desk to call UF Shands, the CSR that answered stated they have sent the paperwork over twice. I give them the direct fax number and the fax machine on the desk at Quest is out of paper, then jams, then is out of ink. Once paperwork is faxed over, phlebotomist begins my bloodwork draw. Phlebotomist contaminates the first H. pylori test, then gives me another one as I sit there. I am flaming mad by the time I'm able to get out of that place, 4 hours later.
APR 27- Followed up with psychologist?s office to ensure paperwork was being sent over to UF Shands.
MAY 9- Followed up w/ PCP?s office regarding referral to sleep lab as I have not heard back from them yet. Stated they are a week behind in making referral appointments and I should hear back from them in the next day or two.
MAY 10- Final nutritional consult at 09:00hrs with registered dietitian via video teleconference. Scheduled appointment with a local sleep center for testing.
MAY 16- Initial appointment with sleep center at 10:30hrs, went to an extremely crowded pain management center for the appointment but was seen within 45 minutes as I was not there for pain mgmt. Was told by the physician it could take up to 14-21 days for an approval for a sleep study.
MAY 24- Monthly appt w/ PCP, told him the sleep center required an initial appointment for an assessment even though my PCP was the one wanting the study done before they would get the sleep study going
MAY 30- Sleep lab 14 day mark to check in, spoke with secretary. She says nothing has been approved yet, they are still waiting.
JUNE 4- Sleep lab 19 day mark to check in, spoke to secretary, says nothing yet, still waiting on approval. Asked to speak to the person that does the pre-approvals, secretary stated she was ?out of the office for the rest of the day.?
JUNE 8- Sleep lab 23 day mark to check in again, spoke to secretary again. She says it was not approved, denial on June 6th, says they sent in for a home study test instead. Will take more approval time.
JUNE 22- Sleep lab 37 day mark, spoke to secretary. She says no approval yet, they?re still waiting.
At 11:15am, I decided to call CareCentrix because that was the name on the denial letter from Florida Blue. Found their website and called their 1-800 number. Spoke to CSR, was told that CareCentrix gets things approved or denied within 7-10 business days, not 3 weeks as previously told to me by the sleep lab. I was also told the original claim was not sent in for approval until May 31, the day AFTER I called the first time to follow up and was told by the secretary they were waiting on approval-they hadn?t even sent it in yet! The denial was sent out June 6th (exactly 7 days later, as the CSR had said), however it was sent with an attached APPROVAL for home study pending the sleep lab?s return agreement to perform the home study. I asked how long the approval would take once the sleep lab sent the return agreement in, the CSR stated it was already approved so the turnaround would be less than 1 business day, usually same day approval.
Called the sleep lab back again and got the secretary. I asked to speak directly to the person that submits the request for approvals. Secretary stated she was not there. I asked when she would be back. She said she would not be bac****il Monday. I asked her if there was a good time for me to make an appointment to come up there and see her because I had called CareCentrix and knew the dates things were submitted and that there was nothing submitted for approval for a home study. I told her also knew there was nothing submitted until after I called the first time to find out if I was approved. There was a 24hr turnaround on the approval I was waiting on and I had now waited 2 weeks, going on three. I wanted to know why I was being jerked around and lied to from the very first time I called to find out about anything. Secretary put me on a brief hold and came back on the line to tell me that the ever-mysterious ?person who does the approvals? would be calling me on Monday.
Wrote to insurance specialist and asked if I absolutely MUST do a sleep study as I had scored only 4/10 on the apnea questionnaire and explained the sleep lab in my area was doing a good job of giving me the runaround. Insurance specialist replied and stated the physicians had already requested it and it had to be done, to be persistent. I called sleep lab at UF to schedule an appointment d/t local sleep lab taking so long to get anything done.
JUNE 26- Monthly appt w/ PCP, let him know I?m still waiting for my sleep study and the sleep center has lied to me several times about ?getting approval? for the study to be done. PCP visibly irritated by my information as he is pushing for my WLS and has his office contacted the sleep center directly to schedule.
JUNE 28- Sleep study approved for home study, picked up equipt for home sleep study from sleep center
JUNE 29- Drop off equipt to sleep center
JULY 2- Results of sleep study sent to PCP's office, PCP faxed them over to UF same day. Cancelled appointment with UF Shands sleep lab as it was no longer needed.
JULY 3- Called UF, front staff stated no chart updates.
JULY 5- Called UF for an update, was told insurance specialist was working another person?s position on week of July 2nd thru July 6th d/t vacation time for other person. No updates in chart as of this date.
Wrote insurance specialist via MyChart messages letting her know I had called and just wanted to make sure she got the documents, that I was ready to move forward.
JULY 10- Reply from insurance specialist in MyChart messages stating she got the sleep study and weight loss paperwork and the chart was in review at this time, she would let me know when the chart came out of review. Assuming that it had been completed and turned in the day before (Monday, July 9th) I started my 30-45 day count from then.
JULY 11- Wrote to insurance specialist via MyChart messages asking if the UF website?s claim about the chart taking 30-45 days for review was accurate as that appeared to be a lengthy amount of time.
JULY 12- Reply from insurance specialist in MyChart messages saying the review included the physician?s review of my pre-op work-up plus the approval time for insurance which normally took 15 days from BCBS FL.
JULY 25- Monthly appt w/ PCP
JULY 31- Called BCBS of FL to check and see if there had been any pre-authorization requests for bariatrics through Shands. Service rep stated there was nothing in their system as of yet.
AUG 7- Wrote to insurance specialist via MyChart messages (29 day mark) checking in to see if there was anything I could do or anything more that was needed from me.
AUG 8- Reply on from insurance specialist in MyChart messages saying the review was not over yet.
AUG 16- Called BCBS of FL to check for pre-authorizations from Shands, again Service rep advised me there were no requests at this time.
Wrote to insurance specialist via MyChart messages (38 day mark) asking whether the 30-45 days was business days or calendar days.
AUG 17- Reply from insurance specialist in MyChart messages saying she believed it to be straight calendar day, but she had not heard anything yet about my review and would let me know.
AUG 20- Called UF on Monday at 10:23am (43 day mark) and spoke to CSR, stated she could not see anything in the chart on a review, however she was going to send a message to the insurance specialist to see if she could better explain why it was taking so long. I explained I was not trying to be aggravating, I just knew that the 45 calendar day mark was coming up on Wednesday and it had gone in for review right after the 4th of July. I thought it may have been easier for me to contact the desk directly instead of hassling the insurance specialist with another email. Message sent from front office staff to insurance specialist regarding my question.
AUG 20- Reply from insurance specialist in MyChart messages forwarded from the review team:
?Patient scored 4/8 on sleep questionnaire. She cancelled her appointment with Dr. Eisenschenk. Did she get a study done somewhere else? Does she have OSA and need CPAP? If so, will review, if not, will need to have specialist eval of symptoms related to OSA.
If you had a sleep study done please have it faxed.?
Wrote back to the insurance specialist and explained that she told me she had received the weight loss and sleep study paperwork on July 10th, but I would call my doctor?s office and have it re-faxed. Explained why I cancelled aforementioned appointment.
Called PCP?s office and left a message asking the ladies to re-fax my sleep study to UF if possible ASAP, the chart is in review and that?s the only document they are supposedly missing.
Reply from the insurance specialist via MyChart messages stating she only forwarded what was sent to her, she will look for the paperwork.
Reply from the insurance specialist via MyChart messages stating she found the sleep study documents, she is forwarding their location in my chart to the physicians for review.
AUG 28- Message in MyChart messages from the insurance specialist stating my surgery request had been submitted to insurance, she will let me know the outcome
AUG 29- Monthly appt w/ PCP, updated him on the progress toward surgery
AUG 30- Called BCBS of FL and spoke to CSR, she stated they received the request for prior authorization on Tuesday, August 28th and that it was currently ?on hold? meaning it was being reviewed by the authorization personnel. She stated it could take 10-15 days for an approval or denial.
SEPT 4- Called BCBS of FL, stated that approval was still ?on hold? and waiting for decision.
SEPT 5- Called BCBS of FL, stated that approval was still ?on hold? and waiting for decision.
SEPT 7- Called BCBS of FL, stated that approval was still ?on hold? and waiting for decision.
SEPT 10- Called BCBS of FL, stated that approval was still ?on hold? and waiting for decision, but should have an answer by tomorrow judging by the date it was submitted.
SEPT 11- Received a call from the insurance specialist at Shands, insurance has approved my procedure and she needs to know if October 19th is acceptable for surgery date. Stated she had to make a few other appointments before she could confirm for sure, but she would call me back when the appointments were made. Throughout the day messages alerting me from the MyChart app show various appointments being scheduled for the same day d/t my having to travel.
SEPT 12- Received a missed call and voicemail from the insurance specialist at Shands regarding my appointments. Checked the MyChart app and found she had written me an email to call her. Called Shands and was unable to get through to her, CSR wrote her a message in MyChart from their end and let her know I called and I had my phone available.
Received call 20 min later from the insurance specialist explaining upcoming appointments. 3 appointments scheduled for October 1st for pre-op requirements including an anesthesia consult, a pre-op consult with the nurse specialist, and a 2 hour nutrition class regarding pre- and post-op care. Surgery date confirmed for October 19th. Follow up scheduled for November 5th.
Made reservation for hotel in Gainesville for night of Sept 30th.
I will come back and update as time progresses. Hopefully this will help someone that's looking for a timeline to surgery, a requirements list, or insurance approval timeline.
Oct 1- Attended pre-op appointments with anesthesia, the surgeon's PA, and with the nutritionist plus the RN Coordinator. Was given a folder with piles of information, also includes a code for an online study course to further explain the surgery and what's expected before and after as well as nutrition pointers. LOTS of contact info and information for post-surgical support groups provided. Instructed on pre-surgical medications, what to take, what to stop, precautions, exact specs of the procedure, what to wear, what not to wear, who can stay with me, possible complications, where I'll be for recovery, and when to start my pre-op liquid diet. Was informed that because I live far from the facility, to be in Gainesville the night prior to the surgery and call the scheduling desk between 7-9pm for instructions on when to be there. Was given 3 chlorhexadine scrub sponges in silver cellophane to bathe my abdomen with each of the 3 days before my surgery date. Nutritionist gave me a pile of samples from various protein powder companies and vitamin companies.
Marked my calendar with reminders for things before surgery (dietary/medication wise), made reservations for the night before surgery at hotel in Gainesville.