Waiting.......

We submitted my request for coverage to Healthscope PPO of Oklahoma on July 28, 2006.  Started with a fax to get the info going and also by certified letter.  They started with saying they never got the fax.  Finally got the letter and the waiting began. On September 1, 2006 - I was denied.  I got the last bit of information that they needed and faxed it in and on September 8, 2006 - we were back on track.  Or so I thought.... Found out that my file was just sitting there with the new information just sitting there - waiting for someone to take it back to the medical reviewers - but no - it just sat - very lonley. I call and they are hateful to me.  I was told because it was accidentally sitting there unattended that it was now in "excellerated status".  I called yesterday and found out there is no such thing.   I know I haven't waited as long as so many others have.  The fact that I have no control over this situation is killing me. Who do I need to talk to?  What do I need to say to them to get the process going? I don't want to hear anyone tell me I'm just going to have to wait it out.  There has to be something more I can do. Tonja

I would first start with finding the contact info for your state's insurance regulatory agency.... call them and ask them what (if any) is the time frame in which your ins. co. must provide a determination... and also mention what happened in your situation. to be honest, the state doesn't really much care how NICE your ins. co. is to you, so I wouldn't bother mentioning anything regarding that... but the state DOES care that your ins. co. follows the rules that the state mandates.  There may be some contact between the state agency and your ins. co if the state feels your complaint warrants being looked into.

even if they don't conduct a formal investigation, if your ins. co knows that you've made a call to the state, at least they'll know you're not messing around. The fact is, you DO have control over the situation.... at least, more than you THINK you have.

good luck