[Cherri]

I was wondering from those of you who have gotten approved or as far as I have the following question. First I will explain I went to the Surgeon for the initial consultation in March. I had previously had this surgeon clear up some scar tissue from previous abdoninal surgeries. The surgery he did was in December. Ok onto the question, they sent my papers into the insurance, and said usually the first answer is a denial. Now, its been some time, and they have called the insurance company (BCBSIL/PPO). What I am wondering is why it is taking them so long with it. I just went and signed a release at the surgeons office today. I had to as my PCP had his copier break down, so they can fax the surgeons office with the 5 years of medical history. Now all that is standing between me and the end is the next 5 months with will end the 3 of October. As this is the end of the 6 months of diet and exercise they want. The surgeons office told me if they don't hear anything in the next week they will call again. I guess I am just a little frustrated as to what is taking them so long. Anyone else run into this, is it just BCBSIL/PPO? TIA

[fr1endly2]

I had Empire BCBC PPO and my approval came first try and fast.
PERHAPS the doctor didnt send everything i know my surgeons
office sent off a huge package from all the doctors clearing me
for surgery, listing my comorbities....perhaps things were missing?
ITS hard to say what the delay is but no news is GOOD NEWS.
HANG in there its a difficult time!!!
GOOD LUCK and i have my fingers and toes crossed for you

[MsVickie]

Hi Cherri. Im a big growler when it comes to insurance issues. First call the number on your insurance card. Let them look up your number and let them tell you what they have received. Then ask them what you status is at this time. Then if they have not made a decision ask them how long it takes to make a decision once they receive the paper work. Write that down along with whom you spoke with. Any of this information I would relay back to the Dr's that are trying to get you approved. During this time I would ask the insurance company exactly what guideline you have to meet to get approved. Write them down. Now Im one when they tell me OK we have 14 days to complete this look at your calender and say to them, OK so I will call you back on April th to make sure yall have done this. They have to document everything they tell you and what you ask and tell them.

It makes me just ill thinking of all the monies we pay to insurance company's yearly and how many times they will deny and stall. If I ever find a movement going to Capital Hill wanting for this surgery to be mandated as medically necessary no matter what policy you have I will be with them. This is just a start on your road. Just write down everything and every call you make and make sure you get there name. Good luck honey.

[Exhorter]

Good info MsVickie. I often forget to keep track of whom I speak with but I am learning.