Why is it taking so long?

Thread Starter  

I finally met all the requirements and my surgeon's office said they sent all of my info in on August 7. Then on August 18 they said they submitted a little more information. In the middle of September my DH called the insurance company and was told the information was received on September 2. HUH??? That was almost a month after the first submission! So he called the surgeon's office and was told that they sent it on August 25. Why did they tell me, to my face in the office, that it was sent in earlier? So he waits a week and called insurance again (Sagamore) and was told it was sent for outside review. It's been 12 days now! I'm so discouraged and fearful of being rejected again. (I was rejected 20 months ago because I didn't have 6 month supervised weight loss, which I have now, but I don't meet the BMI requirement anymore because I lost 16 pounds. I still have the co-morbidities.) I almost went the way of gastric bypass, and I think my journey would have been smoother and I could've had the surgery by now. I'm very frustrated and about ready to throw in the towel. Sorry, I just needed to vent.

Don't throw in the towel yet. Most insurance companies allow as much as 30 days to review the information. When they send it for outside review, they send it to nurses or doctors on staff to go over the information and compare it with their requirements. Some companies are faster, and others go as slow as molasses. Do you remember how long it took for the first denial? If this is taking longer, it could be a good sign. Keep the faith!

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Banded 09/25/08-Dr. Jaime Ponce-Gastric Band Institute

clickersister. I am going through the same thing my appeal was sent to my insurance company on August 18th.. When I called to see if it was received they told me yes. Then I called 2 weeks later to check the status and was told it was sent to the wrong place and everythign had to be re-done.. Then I was told that on Sept 3 it was sent for outside review. When I called again on the 15th they gave me the # for the outside review place and they told me they just received it. So I called my insurance company again on the 22nd and they called the 3rd party and I was told it would take 1 to 2 more weeks. I definetly feel your frustration. I had a friend that submited after me and has already been approved and had her surgery that makes it 2 times as hard.. But just hang in there. It will be worth it in the end

Calm down and hold your horses. You know some of us had to go through the same waiting game that you're going through. Just chill
In my case the Surgical Center had to threaten my doctor's medical records department for my records. They just didn't want to do the work of looking through 5 years of medical records to prove that I had tried different methods of weight management. The information was right there in my medical records but it took a lot of calling and bugging them to do the job and send it over to the Surgical clinic so that the surgical clinic could send it over to my insurance com. I could've banded in June or July. But I was banded in August which is cool because what's meant to be will be.

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Thread Starter  

Thanks, tmbowe.
Yes, it is frustrating. Early last week my dh was told that the outside review board would make a decision this week. Well, it's already Friday afternoon and of course, we've heard nothing. I'm under the assumption that's a good thing, because it only took two weeks to reject it the last time.