BCBS approval info

In talking to BCBS today, I found out that requests for WLS that are submitted WITHOUT a surgery date on them are put at the BOTTOM of the pile. They do not work the approvals by when they come in, but by the listed surgery date. I said to the lady, so because my surgeon waits for approval to set a surgery date, my approval will be at the bottom of the pile until someday you run out of paper work and have time to get to it. SHe said, "Uhhhhhhhhhhhhhhhhhhhhh, well, yes!" They didn't have my name listed in the computer, and she was telling me to have them resubmit it. She asked when my surgery was scheduled for, and that is the only reason that I found this out. Logic would demand that it not be continuously put on the bottom, but reality is what we are stuck with. When I called the surgeons office, the staff told me that they always submit them this way. She kept arguing with me, and said that BCBS never told them that is what is done. (The BCBS lady told me to put a estimated surgery date on it, for the purpose of approval. But the office lady said that was impossible... ) At this rate, I will be waiting for lull in people wanting surgery. I am just mentioning this so everyone else out there can avoid the snag that I have hit.

Never heard of a such a ridicules thing in my life. I did not have a surgery date set until I was approved. I was fighting my insurance company and so there was NO way to put a date down. There are surgeons that do set surgery dates when they submit the paper work to the insurance company. Tell your surgeons office to set a date. Donna

Maybe other surgeons are submitting with an estimated surgery date while fully expecting to change it to whatever is needed later. Someone else mentined that their surgeon sent in a date even though an actual one had never been set. A response was given to them that it didn't sound right. Maybe this is why. When I tried to talk to the lady in the office........ she blew me off. But I am going to go to the next weight loss seminar at the hospital and talk to the surgeon. I intend to tell him of my conversation with the insrance company, AND how his office worker blew me off. The lady at the insurance company suggested that we put an estimated date, to avoid the problem... so obviously, it is ok to do that.

Good idea. Go right to the top. If you don't speak up for yourself nobody is will. Be HEARD!!! Best of luck Donna