Who do I light a fire under at the insurance company???

picardy3 · 02-07-2006, 10:43 PM

I'm not exactly sure when all of my paperwork was submitted, but I think it was about 2 weeks ago. I'm going to call my dr.'s office tomorrow and find out for sure, but I'm curious as to who I might call at the insurance company so that I can be the squeaky wheel.

Lucky me, I've got BCBS of TX.

:p :( It's not like they didn't ask for my entire life history anyway, now I have to wait for them to decide if I'm worthy of something that will help everybody in the end.

Just wondered if anybody had any ideas????

Audra

**Alexandra** · 02-08-2006, 05:05 AM

Audra, go ahead and call member services and tell them you want to make sure that your doctor's request for precertification was received. Be prepared to be transferred to a department called medical management, care coordination, or something like that. But maybe member services can answer your question.

It is your right to know if this request has been received and if the file is complete. Don't take "we can't tell you" for an answer. If the request is pending because something is missing, they must tell you that.

Don't be intimidated. This is YOUR health at stake! Go ahead and call, and if they tell you they're waiting for "more information from the doctor," call the doctor and tell them you want to help get it completed. Find out what's missing and see if it's something you can provide. Be nice, but be a squeaky wheel!

If your file is complete, there is likely a regulation somewhere dictating how long they have to respond. Ask when you're on the phone how long the turnaround time is for precerts. Whatever it is, they must abide by it.

Good luck! Our fingers are crossed!

Mvpo8961 · 02-08-2006, 05:24 AM

I haven't seen the law but I live in TX and my surgeons office manager told me the insurance co has up to 30 days to send back an answer. M

MyKdsDad · 02-08-2006, 09:35 AM

I know it is of little comfort when you are ready to get on with it, but it has taken a lifetime to get to this point. A few more days, give or take, isn't so bad.

picardy3 · 02-16-2006, 08:26 PM

:update:

I spoke with Customer Service at my insurance company. It seems my file has made it past the RN review and is now waiting for the DR to review it. They told me that he's had it since 2/8 so hopefully he'll get to it soon.

I did ask if there could be any missing information and the rep said that since the RN didn't send it back, then it should be complete.

Why is waiting the hardest part?????

Audra

ReneBean · 02-16-2006, 10:09 PM

Good Luck, Audra! If you haven't heard anything within a week, I would call again.

:]

Mona · 02-20-2006, 06:43 PM

Hey there! How are you today? I saw where you had BCBS of TX. Well, I've got BCBS of TN. I also saw where your info was sent on the 8th. The nurse at my surgeon's office said my ins. co. received my letters and info on the 8th of this month. They sent it certified mail so the insurance company would have to sign for it. I talked to my insurance company and the lady said that assuming all the info they need is there then, it generally takes 7-14 business days to receive a response about approval. Feb. 27th will be exactly 14 business days but I'm thinkin' I'll probably call them tomorrow and check on the progress. Just hang in there and be persistent. I wish you well.

danaclark2 · 02-20-2006, 07:13 PM

I'm right there with you guys--Waiting-for-the-insurance-to-respond stage. I, like you, Carroline, have BCBS of TN/PPO.

I believe it's been about 5 business days for me now. I'm really anxious to hear a reply. Hopefully, it won't be long now.

I'm trying to figure out--if you've completed all they require, why any insurance company would give you a "No." Any thoughts?

picardy3 · 02-20-2006, 08:22 PM

I really hate this waiting stage. You just never know what the person on the other end is thinking when they review your file.

The insurance person at my surgeon's office told me that the insurance company has 90 days in TX to make a decision, but I'm planning on calling them at least once a week to make sure they don't forget about me. :p :heh: :heh: :heh:

I've met all of their requirements and jumped through every hoop they asked me to. You would think that they would rather pay for the surgery rather than all of the medications, dr. visits, etc. that I have every year.

Good luck to all of us!

Audra

Mona · 02-20-2006, 09:04 PM

Hey there Dana! Well, I started this journey a little over 2 yr. ago with another insurance company--United Health Care. They were going to pay 90%! However, I was in the middle of a divorce and when it was final then I lost my health insurance(it was through my husband's work :( . I have learned since then that a large # of health insurance companies will turn down a perspective candidate for this surgery. Then the patient has to go through the appeal process. My doctor told me that this was normal and that some insurance companies wanna know who is serious about this and if they will be persistent. I'm very sure that you and all the rest of us are very serious about having this surgery and for some of us, it is a matter of life or death. I'm not trying to write a book with this answer but I guess I just want you and everyone else to know that persistence will pay off and when insurance companies say "No", sometimes they are just trying to weed out the fickle candidates. I would really like to talk with you some more about this or anything else involving this surgery. I'm just so excited that I finally get to discuss this with a tennessee person with BCBS :). I look forward to more messages from you. May God bless you through this walk.

Mona · 02-23-2006, 06:27 PM

Hey there Audra! Read your message just now. The nurse at my surgeon's office told me to call my insurance company every 2-3 days to check on the progress. I was nice and waited a week first...lol. Anyway, my info was reviewed on Feb. 8th and the nurse that reviewed my info at my ins. co. (BCBS of TN) sent a reply back to my surgeon's office on the 16th. I definitely understand how you feel. I'm jumpin' through all their hoops too. I am morbidly obese and have all kinds of co-morbidities and I have had a psych eval many times over within the past 10 yr. of my life. However, the ins. co. told me that they needed documentation that I had been evaluated within the past 2yr and they need documentation that I had tried structured weight loss within the past 2 yr. as well. The ins. co. has been sent all kinds of medical documentation about my depression and weight gain (and weight loss) from the past 7-8 of my life but they want more so....I'm gonna give um' more...lol. Just don't give up!

picardy3 · 02-23-2006, 06:57 PM

Well I just got off the phone with BCBS of TX. Lovely bunch of people. NOT!!!!!!!!!!!!!!!

I called last week and everything is just fine and they have all of my information and the DR should be reviewing it soon. I thought, "OK, this seems to be going smoothly." Boy was I wrong.

Gave them a week and called back to see what was going on. Kristi was very nice and looked through my file. As of right now, they are denying me until they get my psych evaluation to make sure that I'm not crazy for wanting to do this. What's really bad is that I did my psych evaluation on Jan. 17, 2006, and BCBS has already paid the claim to the DR that I saw.

So now that it's after hours and I can't talk to anybody at the surgeon's office I have to sit and stew until the next day. I've sent the person an email that handles the insurance problems and I've called the answering service and left a message so they will know ASAP what's going on and now I'm venting on this board because I don't know what else to do. AND I"M NOT GOING TO EAT OVER THIS!!!!!!!!!!!! (My favorite way of handling stress)

Luckily I have my diabetes support group meeting tonight so I can go and vent to people that I haven't even told what I'm doing, but they totally understand things that go wrong.

I've jumped through all of their hoops and somewhere along the way they dropped one. Not me!!!!!! I've seen the DR's and paid the bills and waited and waited and waited and waited and I guess I'll wait some more.

I was hoping to do this over Spring Break so I wouldn't have to take time off from the kids at school, but if this delays things for another week or two, then screw em. I'm taking however much time I need. I have plenty of sick days and I've had perfect attendence for the past two years so I deserve to do something for ME. Hmmm at least now I can think about doing something fun over Spring break since it doesn't look like I'll be having surgery until later.

Well, I feel much better now.

Audra

picardy3 · 02-24-2006, 12:25 PM

:clap2: :clap2: :clap2:

Thanks to the lovely people at my surgeon's office, my psych eval has now been taken care of. Wonder what BCBS will try to lose next to discourage me?????

TOO BAD!!!! I will fight them tooth and nail for this. :heh: :heh:

Audra :)

danaclark2 · 02-24-2006, 03:50 PM

I have BCBS of TN. Just called them today, and finally, they have all needed documents in the system. They said they received all the paperwork on Feb. 15 and are just now getting to it...

Anyway--I'm gland they have everything...now I wait for an answer...

Good luck to you all.

picardy3 · 02-24-2006, 03:54 PM

Dana,

Was this your first call to the insurance agency? I called last week to check on mine and they said they had everything and that if anything was missing it would have been kicked back to the surgeon's office. When I called yesterday my psych eval was mysteriously missing.

Makes you wonder what they actually do to see just how bad we want this procedure???????

Good luck in your wait. I'm right there with ya'.

Audra :D