Callin the ins co while waiting for approval???

Jayna R.
on 2/19/09 11:57 pm - Loganville, GA

I've read conflicting things on this board about calling the ins. co. while waiting for approval. I'm curious, what did you do? Call them or just wait patiently? My paperwork was submitted on Wed. Feb 18th. I have Aetna Choice POS II. I did the 3 month multi-disciplinary plan. My BMI is 44.
Thanks!

  Jayna
Lap RNY 3.23.09
Ht. - 5'8"
Highest Wt. - 295       Current Wt. - 166      Goal Wt. - 150ish
I've lost 129lbs!
ajordan
on 2/20/09 2:45 am - Albertville, MN
I know I didn't wait patiently!  I called every day and nicely asked for an update.  When they told me it was still "incomplete", I nicely said thank you and hung up.  They were very nice about it and I never talked to the same person twice, but I know that they keep records, so they knew I had called a lot.  My paperwork was submitted on 2/4 and I got approval on 2/11 - I have BCBS of MN.
Jayna R.
on 2/20/09 10:30 am - Loganville, GA
I can't stand waiting! It's like now that I'm this close, i just want to know already! I think I will call them on Monday to check the status.
  Jayna
Lap RNY 3.23.09
Ht. - 5'8"
Highest Wt. - 295       Current Wt. - 166      Goal Wt. - 150ish
I've lost 129lbs!
Nan2008
on 2/20/09 10:34 am - Midland, MI

Hi Jayna, 
I have Aetna PPO and I also did the 3 month multi-disciplinary plan.  I was denied at first because my surgeon's office sent in my paperwork too soon.  I had not completed the 3 months yet.  It ended up being ok though because then I was able to talk to someone from Aetna who specifically said, make sure you do not appeal before 90 days....when they say 3 months, they mean 90 days.  So I made sure my appointments were stretched over 90 days.  I submitted an appeal, including a letter from myself, a letter from my doctor, along with my medical records which showed the documentation of the requirements.  For the 3 month multidisciplinary program I saw the dietician 4 times who took notes and sent them to my physician.  I saw my pcp 4 times who documented everything.  I saw an exercise specialist who put me on an exercise program.  the hardest part for me was wondering how to document the 'behavior modification' requirement.  My PCP and the dietician and I talked about behavior modification and they made sure to document it in each visit.  Plus in my letter, I mentioned the support groups I had been going to and the OH online support. 

I faxed in my appeal on Thursday about 4:30pm and I got the call the following Tuesday that I had been approved.

Good luck to you!!!! 

Chris S.
on 2/20/09 11:12 am - Tempe, AZ

First submission I did call several times for an update and they were very nice and it took approx 4 days I believe for them to deny it because I did not have 6 months of exercise documentation.

I then did the 3 month multi disiplinary plan and according to their information they have two weeks to make a decision.  They took EVERY single moment of those two weeks and when I did call to get status I was basically told  they have two weeks to make a decision and call back after the two weeks.  I got the same answer each time I called. 

I am sure it is all depended on the mood of the day with some of these companies.

CaliMom
on 2/20/09 11:35 am
 Call and bug them. They won't deny because you're a pain in the a**. Usually it goes much faster if you bug them because they want you to stop calling. I called everyday until I got a decision. I was always very sweet and pleasant but tenacious. Best of luck hope you get an answer soon. CaliMom
(deactivated member)
on 2/21/09 6:44 am - Woodbridge, VA
Call. Ask. I called every day, which is how I found out Aetna had requested more info from my surgeon, so I called them to make sure they were respoding. Had I not called them, who knows how much longer it would have taken.
2_be_me_again
on 2/21/09 11:53 am
I have Anthem Blue Cross PPO.  My surgeon submitted my claims last Friday.  I was told - Anthem is typically pretty fast with responses. I had been patiently waiting all wee****ill this past Friday came and I heard nothing.  I decided to call Anthem to see what the progress was. The guy told me my claim was still being reviewed and that the Anthem doctors had a couple of questions for my surgeon.  Once they discussed - a decision would be made.  I was relieved to hear that etiher way - weather they would be denying me, approving me or still in progress as was the case.  I am hopfully having VSG on March 30th if they approve.

All the best your WLS adventure...

-To Be Me Again
AT GOAL in 336 days...!
SW / CW / GW
299 /174.5/ 175
6' tall - size 10

              









R. c
on 2/22/09 10:58 am - nashville, TN
I called, on the pretense I was making sure they had received all of my information. Info was submitted at the befinning of the week and I called at the end of the week and was told over the phone that i was approved. I got my letter the next week. :)
~* Rosie *~      2-16-10  
 











Vicki Browning
on 2/22/09 2:24 pm - IN
You have the right to call them everyday to check the status of a pending review.  
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