Getting the run around...

So my packet was faxed to my surgeons office over 3 weeks ago. I have been following up a few times a week. Last week I was told I would have an answer within 1-2 days. So yesterday I called my insurance co and got a call back today. They have NO record that there is even a claim started for me to have surgery. I am so ticked. I have already verified my benefits with my insurance co and have followed those guidelines and KNOW it is a covered benefit. The guidelines are 35 BMI with 2 co-morbidity's or 40 BMI with NO co-mortise. My BMI is 47 and I have 3 co-morbidity's. Also facility MUST be a surgery center of Excellence. Mine is. So according to my insurances guidelines I should be approved. Good thing I am following up with the insurance CO and Dr.s office and am on top of it. So now I am waiting for a call from my patient advocate. UGH.

Oh how very frustrating....good thing you are on top of things!!!  Hang in there, it will happen and when it does, you will be so excited and it will be worth the wait .  Have a great rest of your day!!  Sarah

Honestly, the hardest part is the insurance and waiting!  I feel for you!  Your surgeon's office should be on top of it but you have to keep on them.  I have Humana HMO.  They were dragging their feet all the way up to one week before my surgery!  I was already on the pre-op diet when my surgeon's office called saying they were calling Humana every day and getting no where.  My PCP's group of doctors didn't have a COE.  So I had to go out of their system.  Humana oked the surgery, but then the doctor's physician group didn't want to pay for the surgery since it wasn't in "their" system.  One big mess.  My husband finally called.  I don't know what he said but he got an answer 2 hours later.  My advice.  Call everyone.  Stay on top of all the paperwork.  And get the approval in writing.  I never did get the final approval in writing.  They paid but it made me nervous.  Hang in there!  It is so worth it.

Been there doing that.  I just received my denial letter yesterday because they stated that they didn't have 5 consecutive years of weight history...  they had 2011, 2010, 2009, 2008, and 2006.  They said it had to be 5 consecutive and because there was a year missing I was denied and would have to go through appeal...  My surgeon charges 18,000 for the surgery.  To date with all the testing I had to get done including a Cardiac Catheterization, they have spent 24,500 on tests...  UMMM  doesn't it make sense to just approve the surgery with 5 non consecutive years...  The insurance companies are a sham and are only in it for the might buck and could care less about your health and welfare.  It shouldn't be called health insurance, it should be called stay healthy and dont use this insurance...

I spent three days worrying about when I would get approved and my insurance company kept saying they didn't have it in their records at all and then on the third day all of a sudden I was approved. I am not saying that this is the case with you, but when I asked my surgeon's office about it they said that sometimes it takes a couple of days for the records to be visible on the insurance companies websites even though it had been submitted. SO maybe that is what is going on. Ill cross my fingers for you! Hang in there...I know how anxious you must be!

That sounds a lot like what happened to me.  Call your insurance coordinator and see if they will check into it for you.    I had been told I was approved by the insurance company, but the Dr. had no record of it.  Apparently, the fax didn't go through. 

I know the waiting is hard especially when you hear about people being approved in less than a week.  Hang in there and good luck.

Waiting is the worst...my doctors office said they would turn it in this past monday and when I logged on to my medical groups site on tueday..there it was!! Pending review..have to admit, I keep checking it  a couple times a day though to see if it changed statuses...lol

So I talked to my patient advocate and would you know today she finally able to verify benefits. I have to meet with the nut and finish my psych eval (the person I picked requires 3 visits and I have my last visit Fri) after I see the nut 1x and they get my psych eval then I can meet with the surgeon. The waiting is killing me. I know it will all be worth it in the end. As of right now, I am NOT approved for the surgery but getting everything done so if I get it I will be ready to go.

On the other hand - the very afternoon I had my psych eval (the last hoop I had to jump through in the process!) - I got a call saying they'd gotten my approval at noon! (Of course, I had to put it off for four monthsbecause of another complication, but, alas...) I was expecting to wait for weeks - maybe even longer. Every insurance company is different - stay on top of it! You'll have good news before you know it! Patient advocates are VERY GOOD at getting things accomplished - they tend to know all the ins and outs of everything. You're doing everything right - hang in there, Sunshine!

I'll be praying you get some good news very soon!


~Karen