Question:
When you call insurance, who do you speak to?

I've managed to get the "customer service" folks at Blue Cross CA (I have POS) to look up CPT codes and tell me the surgery is approved "If medically necessary" though they never give me a definition of "medically necessary". In other words, they are generally unhelpful. However, I have read posts on here where people say "After my paperwork was submitted, I called the insurance company and found it was approved." Did anyone call the customer service people at Blue Cross (specifically CA) and are they able to tell you or do you need to jump through hoops and find a specific person to tell you? Thanks!    — susanje (posted on December 1, 2002)

December 1, 2002
hi i called and got costomer service and i asked them if all my charts had submitted to them for a gstric bypass procedure i did this for 2 weeks they had not recieved anything then when they did she said i was approvedit only took 3 days to get approved. keep on them that is thier job good luck laura poole
   — laura P.

December 1, 2002
When I called customer service with my initial questions, I asked for the precertification department phone number. <br><br> I was transfered to pre-cert after the the customer service dept. gave me the number.<br><br> Then after clarifying that gastric bypass was covered under my insurance, I asked who they had listed as the Director of Health Services for my state (for my insurance company). They gave me a name. I then looked up the main office phone number for my state and asked to speak with the Director of Health Services.<br><br> She helped expedite my request for approval - in fact, I was approved within about 20 hours after the insurance company's receipt of my documents from the doctor.<br><br> This may not work with all insurance companies but it's worth a try. One of the most important things, keep a journal of every phone number, every person you speak with and what's said.<br><br> By the way, I do not have Blue Cross insurance.
   — Deborah N.

December 1, 2002
Hi there, Check out my profile and my "insurance journey" I ended up talking with a bunch of people "during the approval process" and in the end, it was a customer service rep who was able to tell me "you are approved" the only reason she was able to was because they had finally posted the information to the computer. Good luck!!
   — daytymer

December 2, 2002
Let me just say I'm glad you're aware that you know those people are "customer service". The can only give you the standard "medically necessary" jargon. I agree with the previous responder call the pre-cert. BC of CA calls it the UR or UM dept (utilization review or management) they have Rn case managers who look over and then pass the request on to a Dr. (I've worked at a couple of insurance companies and this was one of them ;-) You can speak with any of those people. Do NOT rely on what the CSR tells you...most of them don't know and it really boils down to the pre-cert and claims departments in the end. Email me if you have any other [email protected]
   — Robin J.