jacmay93

Waiting for insurance approval

Recommended Posts

Hi if anyone could answer or help ease my mind that would be great.

All of my information was submitted to BCBS IL on Nov 3 and still no answer I have called every day.  I see all these posts where people had approval in a few days or a week im getting very discouraged.  This last time I called she said with YOUR plan it has to go to a special department and they have 15 calendar days to make a decision.  She said it has been scanned in and is pending.

According to my insurance I meet the requirements and have done everything they have asked, but im freaking out its taking so long.  One reason im concerned is I just meet the requirements.  My BMI is 40 w no comorbilities just a history of over 15 years of being overweight w records to prove from my pcp, who also wrote a letter of medical necessity in addition to my surgeon.

Anyone else on this board w similar insurance and background? 

 

 

Share this post


Link to post
Share on other sites

Your gonna get approved it's about talking to the right people.  When you call in make sure you put all of your insurance info in and if its for the lapland make sure you let them know that.  Also tell them that it's outpatient surgery because they won't look if you don't tell them.  I was told that they have different systems and that their not able to see everything.  I had a nice young lady that explained that to me.  So call tomorrow if you haven't been approved yet and ask to speak with someone that handles outpatient (same day) surgery.  Someone will get you to the right person I promise.  

Share this post


Link to post
Share on other sites

Well its for bypass, I have terrible acid and bile reflux and was told the band and sleeve would make both of those conditions worse but the bypass would fix them.

I called again today and was informed even my surgeon has been calling, so now im really freaking out..

Share this post


Link to post
Share on other sites

Called insurance comany and was told the RN passed my case to the MD Im feeling like this is not good news.  Starting to feel discouraged.

Share this post


Link to post
Share on other sites

I'm sorry you are feeling this way..... I remember like it was yesterday waiting and wondering every single minute until I got a response. Try to be positive  (I know it seems impossible ) what does your gut say? We usually know before we know..... I'm thinking that is just the normal steps, pass to RN then to MD etc.... this doesn't necessarily mean anything at this point. Saying a prayer for you right now. 

Share this post


Link to post
Share on other sites

My gut is not doing a happy dance lol

But I've gone over my insurance forward and backwards even the certificate at by their own policy I qualify

Share this post


Link to post
Share on other sites

Just remember, if for some reason they came back with a denial, the fight is not over. Alot of times it's something silly that was left put or a note here or there that just needs to be fixed and sent back. 

Share this post


Link to post
Share on other sites

Well its for bypass, I have terrible acid and bile reflux and was told the band and sleeve would make both of those conditions worse but the bypass would fix them.

I called again today and was informed even my surgeon has been calling, so now im really freaking out..

I had the bypass because of my acid reflux (GERD) and it took 9 months to get my approval. Sorry to tell you this but I was denied 3 times - the insurance company didn't think that my condition was serious enough - I wasn't able to talk any longer the acid had shredded my esophagus or that I was heavy enough - but the surgeon would not give up and it was finally approved.

Edited by PatriciaAnn

Share this post


Link to post
Share on other sites

May I ask what your bmi was Patricia ann? And your insurance provider?

I have bcbs of il bmi 40 and they do cover bariatric surgery w these requirements 

Share this post


Link to post
Share on other sites

Jacmay, I know you weren't asking me but I will put my info out there for you. BSBC with highmark  (that's union pacific railroad ) husbands comp. Started with a BMI of 43ish but had a big lose with the required 6 months diet and exercise program, lost about 30 which but me barley sliding in at 40.3 day of last appointment and day paperwork was pushed through. No comorbitities other than sleep apnea but no machine, Gerd, arthritis but non of those were on insurance list of comorbitities. Aproval came through in 3 days..... highmark does require a Case manager and from what I've heard that's extremely helpful through this process. If you have any questions feel free to ask, we will get you through this wait!  

Share this post


Link to post
Share on other sites

Great thank you... I should know tomorrow I think... I know mine is a ppo group platinum plan

I just hate to have to pay two deductibles but if I do I do..

Share this post


Link to post
Share on other sites

May I ask what your bmi was Patricia ann? And your insurance provider?

I have bcbs of il bmi 40 and they do cover bariatric surgery w these requirements 

my BMI was 40 and I had Aetna HMO - which while was a pain getting the approval - once it was approved the entire surgery (plus my hiatal hernia was fixed and my gallbladder was removed - I also had gallstones) only cost me $250 - total!  So while it was a pain waiting (I almost gave up a couple of times) I am now a size 4 and feel and look better than I have in a very long time - so for me the wait and frustration was so worth it in the end

Edited by PatriciaAnn

Share this post


Link to post
Share on other sites

Well I was denied...no co-morbilities when my policy clearly states BMI of 40 with no co-morbilities.  Makes no sense.   My guess is its end of year they hope I'll give in as my deductible will reset as of Jan 1.  They may be correct, already paid 1250 and now another 1250 so they can try and divert me...grrr. frustrated 

Share this post


Link to post
Share on other sites

jacmay, maybe you could develop a comorbidity? Or gain weight? Or get shorter?

As much as we agonize about deductibles, if you're like me and meet yours every year, it doesn't really make a difference in your total health care costs.

Only once have I ever met my out of pocket max. Financially that would have been the year to do the surgery. Logistics and desire that year, not so much.

Share this post


Link to post
Share on other sites

Lol....true.  im just disappointed...I'll have my big girl panties on tomorrow ty.

Share this post


Link to post
Share on other sites

Oh man.... this breaks my heart. I'm sorry you got this news but please don't give up! 

Share this post


Link to post
Share on other sites

UPDATE......

I switched surgeons had the CORRECT information sent to my insurance provider and was APPROVED IN 5 DAYS!

Now, I am waiting for a nurse to call me and schedule my pre-op class and surgery date!  I am so excited and anxious and even though it is costing me an additional deductible I am very happy with my new surgeon. 

Share this post


Link to post
Share on other sites

Oh my goodness! !!! I'm sooooooo happy for you! YeS!!!! I've been thinking of you often and was hoping you had news.... this is wonderful news!!

Share this post


Link to post
Share on other sites
18 hours ago, jacmay93 said:

UPDATE......

I switched surgeons had the CORRECT information sent to my insurance provider and was APPROVED IN 5 DAYS!

Now, I am waiting for a nurse to call me and schedule my pre-op class and surgery date!  I am so excited and anxious and even though it is costing me an additional deductible I am very happy with my new surgeon. 

Great news!!! I'm glad you continued to pursue what you needed! Congrats!!

Share this post


Link to post
Share on other sites

Congrats! I have my surgery date now I am just waiting for insurance approval BCBS NC. 

Share this post


Link to post
Share on other sites

So excited for you! 

Share this post


Link to post
Share on other sites

I am scheduled for March 3rd. Good luck on your surgery. Hope my second surgery is the ticket!!

Share this post


Link to post
Share on other sites
On February 3, 2016 at 7:33 PM, jacmay93 said:

UPDATE......

I switched surgeons had the CORRECT information sent to my insurance provider and was APPROVED IN 5 DAYS!

Now, I am waiting for a nurse to call me and schedule my pre-op class and surgery date!  I am so excited and anxious and even though it is costing me an additional deductible I am very happy with my new surgeon. 

My goodness I have bcbs IL and I was reading this post it freaked me out because I'm waiting on insurance now lol. I'm glad to hear you got approved after all! 

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...