How long did you wait?

Hi Guys,  I am new to this forum...but it is so good to see people in my situation or who have been through it that live in my same state!! Anyway for people who have already had WLS, I was just wondering how long did you wait to hear back from your insurance? I know some people had to do appeals and all that but just your initial answer? I'm hearing some people heard back from them within a week or two....

I have BCBS of Michigan (I dont know why i have MI insurance) We submitted all of my information on April 19th and I still havent heard anything. I called last week and they said they didnt need pre-authorization and they werent going to give it and then Dr. Jawad's office said they wouldnt do it without preauthorization. So I had to call the insurance company because it just didnt sound right that they didnt require preauthorization with a surgery this expensive. So after about thirty minutes they finally realized that they had made a mistake and told me to call back the surgeon and have the surgeon's office call them back. So I'm back to waiting after that emotional rollercoaster.  Did anybody else have this problem? Aren't they supposed to give you an answer in a certain amount of time?

Check your policy.  There is usually some language in the policy that specifies the timeline for an initial determination and for appeals. Red

Hi... Different insurances have different guidelines. Check your policy or handbook. Also we are subject to world of people who often make mistakes so always followup on everything. My insurance does not notify the patient so I called after about 2 weeks. I had been approved after about 8 days. I have Tricare and I read that they have fast approval. My surgeon also has had many years of experience and told that that Tricare approval is in about a week. Don't get discouraged.  Keep making the phone calls and followup. Sometimes you have to be persistent.  I have 23 days and a wake up. My surgery date is 06-21-2007. Yea!  I will be praying for you.

Hi there!! Put your trust in Odayls. She is absoultley wonderful, but she is totally overworked at the same token!! Just stay on top of your insurance company. Usually they have 30-60 days to get you an answer. Just take charge and hopefully if you push them along, the answers will come a lot quicker!! Hang in there, I know this can be very frustrating. But it will happen for you!! Good luck, Jo Ann

After three weeks Carefirst BC/BS (Maryland) asked for some more information on my 6month diet, and once the info got to them it was approved in about 3 weeks.  Hearing that approval from Shirley, at Dr. Hipp's office was one of the best days of my life.  She was great, tolerating me calling nearly every day, since I couldn't talk to a "real" person at Carefirst.

I feel you pain.  Odalys submitted by fax last Monday and than again on Friday as BCBS of Florida said they had no record of this request.  Today they told me that they have to image the fax before they can submit it to the correct department.  This image thing can take 1 1/2 to 2 weeks.  I asked why they did not image directly from fax like other company's do that need to image before they can deal with the issue. I asked for a case coordinator and was told I do not have one.  My Doctor does but I do not.  To which I told them that I am the CUSTOMER and that I could have someone directly to talk with about this process.  I than asked for supervisor.  To which he offered to call Dr Jawad's office and find out who's attention the fax was sent.   What a run around.  He put me on hold and tired to call Odalys with no luck as it went to voicemail.  He stated that he would get the info and put it into my notes.   I wanted the notes to reflect that I was an unhappy CUSTOMER and wanted a better system for checking on this.   But, as of the end of the call it got me nowhere.  I plan on calling everyday until I get someone to tell me the info.  He did say that once it is imaged and directed to correct department that approval would only be a few days.   

I will hang in there as long as it takes.  I will also look in my book for time frames.   Good luck, keep us posted on your progress. Sandy Wesley

 

Every ins. co. is different but many seem to drag their feet.  Most can take up to 45 business days to issue a decision.  Also, be aware that every time they ask for "additional information"  or say they never received something and ask you to "resend" it, the clock starts over!   My advice is to call at least once a week (but not on Monday morning or Friday afternoon) and take detailed notes of your conversations - get the name of the person you speak with, ask for your file or case or reference number (called different names by different co.).  Ask specific questions (have they received everything they need, what is next step of process, how long does that take, who should you direct your inquires too, etc)  If after all that you're denied, plan & file an appeal as quickly as possible.  It seems that some companies automatically deny everyone but often approve on appeal.   My request was filed Aug. 19, I waited 1 month & called to check the status only to find out that "they never received" the request.  It was sent a 2nd time, I called after 2 weeks & they never received that request either (see a pattern here?)  After it was sent a 3rd time, they asked for an additional clarification but it was eventually approved in mid November.  The approval process was stressful but well worth the hassle!! Hang in there & good luck!! Vickie J. 

So today I called Odalys again to see if she had resubmitted. She said yes. So I called the insurance company to find out if they received the resubmit. First they tell me they can't give me (the policyholder) any information regarding this and the surgeon would have to call. I didn't like that answer and told them so, then they tell me that they don't have any record of my files being resubmitted only that they would be because of misinformation on their part.  Oh my gosh....I don't understand why I just can't get a straight answer...I mean I know they probably deal with thousands of people every day...probably some that are trying to beat the system. But I don't understand why I am forced to jump through all these hoops and why they are dragging their feet on this issue that is so important to me. I'm sure I'm just a number but it's driving me CRAZY when they won't even give me information about ME...

I have BCBS of Florida.  They don't give pre approval, but they do give pre certification. Slightly different. It's all in the lingo I suppose. Anyways, we just faxed everything this past Thursday before Memorial day. We faxed it all at once. 54 pages worth. I just found out today I was approved. Less than a week.  I was expecting delays and am shocked I didn't have any. I don't know what made the difference and sometimes it seems to be so situational and inconsistent. I'm sorry for the difficulities you've encountered.

Hi,  I initially tried to use Dr. Jawad's office and Odalys to help me through the approval process.  Imagaine my surprise after being told by Odalys that my case was "under review" by Aetna insurance that she had never submitted the paperwork.  I understand that Dr. Jawad's practice is very busy and Odalys is doing her best to do an overwhelming job, but I have a personal problem with dishonesty in any form.  As a result, the paperwork was finally submitted and very shortly thereafter I was denied.  I hired an attorney and fought the appeal process.  Finally, I was approved in April, 14 months after my paper work was supposedly submitted.  I have also changed surgeons and am having the surgery through Dr. Kim at US Bariatrics in Celebration.  I have one more hoop, the cardio clearance, which is scheduled for next week.  Then, I will receive my surgery date.  I hope your experience is less traumatic and disappointing than mine.  My surgery is taking place over a year later than I first expected.