How long 4 Insurance to respond? Revision Appeals?

Michelley
on 7/30/07 1:41 pm - North Platte, NE
From what I understand, my file was sent to insurance on July 9th.  I have BC/BS (I think of Pennsylvania, it's Highmark BC/BS through my husband's employer, which is Union Pacific Railroad. All I know is it's somehow different because they have a railroad dedicated line and none of their info is online you have to call for a booklet and any info you want.)  Anyway...It's been 3 weeks and still no word from insurance and I'm about going nuts waiting!  How long does it usually take to get a response?  Are responses usually sent to you directly or to your surgeon first?  Is this delayed response good or bad for a revision request? My grandmother called today and she has a date at the end of August to have her lap band. She's been waiting for a good 6 or 7 years so it's time that she has it. We thought at one time we could have surgeries together but it's not looking that way.  So I'm very bummed and the waiting is agonizing. I think I'm scared to call insurance and ask about a status even though the worst they can say is it's denied and I start my appeals. I'm not even sure who to ask for or if there is anyone in particular to talk to.  Or should I be calling my surgeon's instead of insurance?  At any rate, I'm already prepping or researching information for an appeal but really need to find some documentation to help with a revision appeal. I'm having a band over my bypass. My surgeon told me after doing an upper GI that my bypass done in 2001, was not done correctly because it would be impossible for my stomach to have stretched to it's current size if it was done correctly. I dont know if that's enough for insurance to say, "ok approved" or if they will deny it and try to come back and say I didn't follow the post-op diet or something. If they do, how do you prove that you were doing what you were supposed to do?  Does anyone know of any documentation regarding why it's beneficial to have a revision or band over bypass revisions? Thanks, Michelley ...who needs more patience
nightrose68
on 7/30/07 9:15 pm - East Brunswick, NJ
According to most posts I have seen and my own insurance (BCBS of NJ PPO) usually the company has 30 days in which to respond. I am currently fighting my insurance company for coverage for RNY and I have no patience myself. I called after 2 weeks and was told a letter was already sent (one I never recieved). They said they would resend it and 1 week later I had to call again as I still did not recieve it. Call your company and request a status update on your claim just make sure you get the name of the person you spoke to for your own records. As far as the last question I cannot help you there. You might try a WEB MD search. Good luck and keep me updated. Linda ...who has little patience herself

Nobody  can make you feel inferior without your permission.  -Eleanor Roosevelt-  

Michelley
on 7/31/07 2:19 am - North Platte, NE
  I finally got the nerve up this morning to call my surgeons and see if they have heard from insurance. They just got information yesterday  that I was approved on the 27th.  Yippee! I haven't got my date yet. They are supposed to schedule me and my grandmother together so I'm waiting to hear for sure what the date it. Should know within the next day or so. They told me they "thought" it may be Sept 11.
nightrose68
on 7/31/07 3:23 am - East Brunswick, NJ
CONGRATS!!!!!!

Nobody  can make you feel inferior without your permission.  -Eleanor Roosevelt-  

gary viscio
on 8/2/07 7:44 am - Oceanside, NY
Keep on them.  They can drag their feet or suddenly tell you they don't even have an appeal on file.   Usual time is 60 days give or take, but stay on them
Gary Viscio
www.ObesityLawyers.Com
RNY 7/1/03  -166lbs
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