Insurance advice/question - time is running short (Federal BCBS)

Ok, so my information was turned in to insurance on 11/4/11 for approval of the DS. I planned on surgery happening in January or February but my surgeons’ office is afraid policies might change or they might make me do all my requirements over since it is a new year. So now… I am on a tight time line to get this all done before December ends. That really isn’t a lot of time considering insurance is not usually the fastest thing. So I plan on calling them today to see if they received my information and if they have started to process it. Kinda get the ball rolling.

My question is …

When do I call them and check status? I am trying to go for nice annoying person. I just want this done quickly so if they do throw a crap denial at me, I have time to put in an appeal letter and continue this process. I normally wouldn’t do this but like I said I am now crutching to get this in.

Why couldn’t it just be in January or February? lol I guess this is the hand I was dealt.

I also have FEP BCBS and I had approval in 3 days.  I do know that the plan has changedsome so that could go into your consideration.  But if you sent the paperwork in on the 4th I would at least wait until tomorrow considering the 4th was a friday.  I know probably not what you wanted to hear.

Betty

Good idea! I didn't even pay attention it was a Friday. I will call to see if they recieved it tomarrow. But when should I call them again? I don't want to be over the top but I do want to be a little pushy because of the timeline.

Daily, I don't think they mind as long as you sound nice.

I have Anthem BCBS.   I had approval in 24 hours for the wrong procedure...looooooong story.  Once the right procedure was sent in I gave them 72 hours to process the claim and then called them daily for a status.   They will say pending but your call gets documented.   As your physicians office to call every two day to make sure they don't want any further information or can't find what is in front of their faces...the docs office isthe only one that can talk to the preauth folks....


I didn't worry about being anything but polite...took less than a week.

The 2012 FED BCBS brochure is out, and there are no  changes to WLS requirements from 2011.   I have already checked and had my surgeons office look at it for confirmation.   Also I confirmed with BCBS that they  will not make patient redo requirements over once the new year turns over as long as requirements were met within the time period specified, ie 3 months nutirtional counsellin in the past 12 months  (this is even true for me who will be switching from another FED insurance plan during open enrollment)   so you or the doctors office should not have to worry about that.    I can provide a link to the nnew brouchure if you want, but the easiest way to get to it is from the OPM website, www.opm.gov.  Both 2011 and 2012 brochures are up there so you can look at WLS surgery requirements in each year and compare.

I have the new new policy for 2012 and I did question the insurance guru at the surgeons office. She said that even with a new policy out they can still change anything for the upcoming days till it is in effect, which is the end of the year. She is a bit nervous to trust them because she has had this happen a couple times. So I am going off of what she knows and also my husbands job is working with insurance and he said this as well. I am just being on the safe side. I would hate to be one of those girls she was talking about, better safe than sorry. It is a small chance I know... but here i go lol

I would call daily. Especially if you're in a hurry. Just laugh and say, "Calling for an update!" I call every few days on my IMR. Just want them to know I'm waiting... And don't be surprised if you get denied the first time around. Around here (Pacificare and Cigna CA) it's standard. It does add time to the process, but don't be afraid to appeal!

Like the others said, make sure they got the paperwork, then make sure they have everything they need, etc...

Good luck!
Lori

Yea I have a gut feeling i might get denied the first time around since I am a lightweight wanting the DS. Even though policy does not state i need to be over 50 BMI. I just have a feeling they will give me a hard time. Another reason I want to speed this up.

I called my insurance "case mgr" once a week from the get go... I would even find some question that I already knew just so I could develop a relationship with her.. I think it really worked.. I was super nice and made her feel very important.. when it came time to turn in my paper work  she called me back in like days with an answer.. she still calls to check on me once a month!  oil that squeaky wheel.. I would just call and make sure she actually got it and go from there.. I was approved and set for surgery in a matter of 2 weeks I believe.