Question:
BC/BS rep took upon himself to submit my letter to the appeal board....

What does this mean? I wrote a letter of frustration and why I needed the surgery and that my date was fast approaching but every time I called, I got pushed from one department to another. My surgery was not being denied, but it wasn't being approved either. So this rep said due to the urgency, he was walking my letter to the appeals board. What does this mean? I called and spoke with a woman from that department. She said they have 30 days to respond, but that I would definitely have an answer before my surgery. I am really concerned because my surgeon doesn't do the pre-op tests for surgery until you are approved by your insurance. What should I do???? Anyone have this happen to them? HELP!    — [Anonymous] (posted on May 23, 2001)

May 23, 2001
Well, what I've read on these message boards is to hound them everyday, that's the only way you'll get action on their part. I wish you all the luck, I know waiting is the worst part. It took me 3 months of waiting just to see the surgeon. I finally saw him on May 16th only to be disappointed. I have BC/BS HMO, which apparently I was told by the surgeon's office that they are no longer approving this surgery. So I am switching to the POS, which will not go into effect until July 1st. Another month and a half waiting. Do you also have the HMO? My worst fear is not to be approved.
   — Natasha B.

May 23, 2001
I wouldn't be concerned w/ the rep taking the paperwork over.. that is great customer service. What is odd is if your surgeyr isn't denied or approved why is this going to the appeals board? I'd double check w/ them what the true status of this is. Do you know what your benefits are and if this kind of service is covered on your plan? If not check your benefits book and look for limitations and exlcusions. Is that normal to schedule a surgery before its approved? I know mine didn't and I wouldn't want them to cuz I want it in writting its ok first. As for the testing.. what kind of tests does this dr do? Are you talking about diagnostics like to check and or confirm for gerd, highblood pressure, sleep apnea etc? If you haven't had any tests for those or been diagnosed w/ that I would think that should be done before they request the auth or how else do they prove medical necessity? Anyway I wish you the best of luck and hope this all works out for you.
   — Dawn R.