How Long Did It Take You?

Hi all. I was just wondering if I could ask a question. I just got my letter from my insurance saying that I was denied, and my doctors are already getting ready to send an appeal back in. How long did it take for everyone else to hear back the second time they sent in stuff to the insurance company? I have BlueCare for insurance. Thanks - Ashley

I think it's going to depend on why the insurance denied it and whether the doctor's office gets them everything they are asking for this time. I have heard of some people who got an approval on the appeal in as little as a week.

Keep your chin up. I'm sure the doctor's office wouldn't be so quick to resubmit unless they felt like they were providing enough info for an approval this time.

The letter said that the reason that the insurance denied it was because I didn't see the surgeon before they submitted the letter, but I did and that the doctor didn't give any surgical history that involved my stomach & belly, any medical conditions or a physical exam. It also said that they called the doctor and he wouldn't give them any information. I had a visit with him about two months ago and we talked about everything. When I called the office today to tell them I got my letter and to tell them what it said, they couldn't believe that it said that because they faxed everything that was in my file. That really kind of frustrats me so much. The letter also said that I meet the guidelines to have the surgery other than the stuff with the doc. That is the reason I am thinking/hoping that it won't take as long as it did for the first time. Thank you so much for your input though. - Ashley

I am sorry to hear this has happened to you..

  From personal experience it would be a good idea to go to your doctor's office in person verify exactly what documents are missing and watch them fax them to the insurance company.  Then when you get home you call the insurance company to make sure they received the needed documents.  If they say yes then ask them what happens next and how long will the approval process take. 

  There are several of us on the board that have experienced this and we know your pain.  What we learned was that we had to stay on top of it everyday. 

  My best to you and let us know how it goes.. 

Hey. Thank you so much for your concern and empathy. I have to go to a different doctor tomorrow, but the office is close to my surgeon's office so I will definitely go there and do that. I really hope that it doesn't take long for the insurance to make their decision, but I guess a few more weeks won't matter because I have been trying to get this surgery for almost 3 years . Thanks so much - Ashley

This biggest thing you can do is stay on top of your on information.  In other words, don't give up! 

After jumping through hoops to get everything done, the insurance company told me I only had 5 months of a 6 month diet documented by my Doc.  I knew I had 6!  After numerous calls, they actually found the last month and everything went from there.

Stay on top of the situation and don't give up!

Scott

I was denied twice!  My insurance company is CIGNA which I was told had a bad reputation for not approving RNY...not true!  They have specific criteria that must be met.  With that in mind, I simply delivered everything they needed in one little package to my surgeon's office.  Once faxed...I checked with the insurance company daily.  Two weeks later...Ta Da!  And the rest is history!

Good luck and don't give up!
Freddie

Hon, everyone is right, don't let it get you down, just make it make you more determined!!!! MyNiceSpace.com

I agree with Susan, it depends on the insurance.  In my case, I really started to pursue it in 2005 when I worked for an agency with an exclusion policy.  There was no treatment covered for weight loss, not only surgery, but also medication and psychotherapy were not covered.  When I transferred to another agency, I started looking into it but still got doors shut in my face.  I had to go through the 6 month supervised diet by a nutritionist, and once that was finished, I still faced some "no"s.  It was from a high school chum that I worked with at this agency that led me to the correct channels.  Once I got my information to all the correct people, it took probaly about a week.  All in all, I'd say probably about 1 1/2 years of fighting the system.  I had the surgery January of 2007.  I also had BCBS. 
Sorry for the long story...but my advice, be pro-active, don't rely on the doctor's offices to send the information to the insurance company, they have many other people they are working with.  Make copies of everything, get all information from any and all doctors you have seen, therapists, shrinks, etc.  I went as far as sending the insurance company a box of slim fast, and a canceled check to weigh****chers.  Just be persistent and pro-active.  I know the frusteration, and it is awful.  I'm not sure if this answers any of your questions.  Good luck to you!