4jin

:huh2::party::banghead:

APPROVED

1/17/08 Exactly on the 30th day!!!!!

loving it!!!!!!

I have to say it again APPROVED..oh..yeah...APPROVED...oh...yeah..

ok enough...

I am calling surgeon's office this morning to let them know. I am sure I need to go in for another consult and I think then I can talk surgery schedule.

Bet your bottom dollar....as soon as I have surgery date.....You guys will know!!!!!!!!!!

HERE IT IS UPDATE!!:huh2::party:

APPROVED!!

4Jin: I am so glad I was wrong and you were right!:pray2: It sounds like you may get an answer this very day! I'll keep praying.

AmyMT: Thanks for the invitation. I would love to be an honorary member of the New Years Knockouts! This is such a supportive board.

StLouisGal, it can vary from State to State -like all darn regulations.

But as mentioned BC/BS thinks they can make their own rules as they go along...

Praying...praying...on my knees...

guys we should make our own buddy-buddies thread under January 2008 bandsters for daily support of our journeys......

Knockout Transformations!!!!

thanks AMY,

OK.....I called Georgia Insurance Commissioners office. They assigned me a rep who called me right back. She informed me 30 calendar days...is what they have and decision should be in writing. especially if it is a denial...

Armed and mad...I called the insurance back...dialed the prior approval number...selected the extention number I got for the supervisor....

she actually answered this time....

she recognized my name right away...looked in what sounded like a notebook and informed me she sent my record about 45 minutes ago to her urgent RN reviewers. She will be hearing back from them in a couple of hours and verified my phone number and said WILL call me back TODAY..

I finally feel like I have complished to splatter some oil on their wheels and it is finally running....

Now I am so nervous lunch isn't even an option....my stomach is doing turns....

I am going to profusely pray that GOD gives me an initial approval.

Please pray for me...

That's it online the prior approval request is not posted...if I call regular customer service...they can't see in the system because prior approval uses a different database. To get prior approval on the phone is a hassle...hang up..call back..hang up..call back...until someone finally answers.

I have never received a letter recognizing they have received my paperwork...and that my request has been pending.

I have documented all the calls, who I spoke with..and what the messages have been...

well I called the Georgia Insurance commission and was told 30 calendar days is their mandated response time in writing...they haven't done that...guess what ...i called the supv back...she picked up the phone...she informed me sent my record to urgent RN reviewer and should hear back decision in a couple of hours. But will call me back today and verified my call back number.

But I do want to arm myself with as much info(which is my ammunition) as possible.!!!

Thanks for your info I had not even realized I have never received anything from them in writing....hehe..

Good morning,

I've had it!

I called just got off the phone with BC/BS...they drive me nuts...

spoke to the same girl from yesterday...yes! and on the first try..yes!

So I thought it would be my lucky day....NOT!

ok....so no denial...but no approval neither..

my record has just been pending there...just plain sitting...out there the frickin' frackin' f'ing supervisor has not forwarded back to RN for reviewal...

The rep was even stunned....she can't believe....I told her I've had it...by law this must be decided today...it is DAY 30!

She confirmed and is just as flabergasted...she emailed that frackin' supervisor requesting she contact me immediately.... I told her not good enough I want to speak to her now...I am getting my decision today...

She couldn't give me her tel# she said. She transfd me to her..ofcourse rings twice straight to voicemail-ok...I think I'll leave a message..nope voicemail box is FULL....I stay on line because it says stay on line if you want to be handled now and the person taking over her calls will assist..it rings...NOT...it goes right back to her frackin' voicemail...and I do this over and over and over...

I think ok....hit * get to the directory...choose to do name look up...I have her name...got two hits...they each say their names..I listened to her message so many times I definitely recognized her voice....it asks to verify I want first, last name at extn xxxx....yes I got her extention number...I let the system connect me and voila....I can all of a sudden leave a message!!!

I will be sending a request contact to the georgia insurance commission today...and seeing about contacting an attorney...i've had it with these people!:pray2:

oh...but I will call today every 2 hours...!

Back to the initial post....By law insurance companies have 30 days to review a claim and give an answer. So whatever time of year, holidays or not, reps on vacation or not, you waited WAY to long for your answer. I would have threatened to take legal action. But none the less, good for you on your persistance! I hope it pays off for you!

Abeaher

do you know where I can look that law up. I need to know if I am calculating 30 calendar days or 30 business days.

Well I recieved my second denial today,bummer I have bcbs hmo. Its the hmo dept. making excuses. First said I need to loose weight did that then said because bmi is 39 they wont approve. Get this I have RA high cholestrol pcos I dont know what else I have to do to get approved.

I am so sorry to hear that tweety.

Yes I would definitely get an appeal attorney to do all the work for you.

Between us...I gained weight as well. I have no comorbidities, but I knew unless I had the 40+ bmi I was going to see denial.

I think that's why its been almost 30 days and I have not heard a decision yet....

but I gained did a bit too well I have to say...and my bmi is 41.5 at the time of consultation. I am back down some-so If I get denied I will have to get back to gaining and probably go past the 41.5 bmi. oh...I also had the doctor office take my height wrong...i uh...seemed to shrink an inch at the consult...(just bent my knees)

cry it out...let it out....then arm yourself...you can win!!

But I think I can because I was an original member here. I was the third person in this forum way back on November 26th in the surgery date thread.

allright!!!!

i would so love that!

congrats!!!!!

But like me, who was originally scheduled for Jan 21, and was rescheduled to 12/31/07, I was made an honorary member here. 4jin you should be too. You have been here for awhile.

Thanks Chrisann,

I think a member of the newyears knockouts can only nominate me...! I would definitely be honored!

4JIN:yes, I am also happy you found someone that took their time. You and me both my not be Jan Bandsters but atleast Feb is less than 14 days way!

Finally, the request appears on the website that I have access to 24 hrs a day but it only tells me the date they got it and status (pending). And you can bet your bottom, I'm pulling and refreshing that site every hr on the hr.

yep, we'll just keep praying that something happens quick...

Question...how long do you have to be on liquids b/4 surgery?

My doc is not going to require me to be on a preop. Liquids just 72 hours I believe.

At least you can go online an see something...mine doesn't even have that as an option. I have to call them. But I am going to everyday from now on.

LOL StLouisGal you are a very loyal special friend to me!

on a sad note...at this rate...I probably won't be a january bandster.

I called the insurance today. Spoke to the prior approval rep that answered instead of requesting to speak with the other one I was previously....this one took her time instead of rushing me off the phone but had the consult with the other one to see who the reviewer was. Came back and told me found out who it was but can't say when I would hear back as she does not know what her caseload count is or what dates she is working on at this time. but told me I was more than welcome to call as much as I wanted for a follow up. I told her I would. She was even alarmed with the submittal date and todays date being 21 business days and 29 calendar days.

back to more praying...at least it was a helpful conversation....somewhat:huh2:

Because insurance companies love it when you have something missing ....gives them a reason to deny or pend for a longer period of time and hope you'll get tired of the wait or having to wait even longer and not continue to pursue.

They are evil even if they end up approving you....they are evil.....

EnchantedRuby,

hang in there I am still waiting too....

No I didn't call today..but I haven't received any calls neither.

darn it...and to top it off ..I was doing to good on my healthier lifestyle change...and now I feel like I've been on a last meal syndrome diet...from the stress probably....

ahhh...I figured it was something like that!

LOL....it's been too cold here to sleep on the floor...!

congrats on your approval!

I am still on the waiting game...but just waiting for insurance approval!

I'm doing great, 4jin! I was hoping you would have heard something by now, hang in there and hopefully you will know something soon. Have you tried calling them to speed up the process a little? I don't know if it would help but it might be worth a try. I've got my fingers crossed that hear soon!

yes it is insane...their stalling tactics....

but I told her I was not going to go away....

I know this has nothing to do with our topic but I came across this a few weeks back...I tried it as well as some friends and we saw results in a little as 1 to 2 days....here it is..

How to break a plateau:

• Do this for 10 days to break a plateau
  
• Drink 2 Quarts of Water a day
  
• You must have 45 grams of Protein supplements and take all of your vitamins/mineral supplements each day
  
• You may consume up to 3oz of the following high protein foods 5 times a day

Beef

Pork

Chicken

Turkey

Lamb

Fish

Eggs

Low-fat cheese

Cottage cheese

Plain yogurt/artificially sweetened

Peanut butter

Beans/legumes

You may also have:

sugar free popsicles

Tea or coffee

Sugar free jello

Broths/buillon

Crystal Light drinks

• If it is not on the list don’t eat it!
  
• Keep a food diary and try to get up to 30 minutes of exercise per day!

Between us I and some friends have seen the scale change within 2 days…some take a little longer but it works!!!

Sorry guys I haven't followed up on this post...but as asked...here is the diet:

How to break a plateau:

• Do this for 10 days to break a plateau
  
• Drink 2 Quarts of Water a day
  
• You must have 45 grams of Protein supplements and take all of your vitamins/mineral supplements each day
  
• You may consume up to 3oz of the following high protein foods 5 times a day

Beef

Pork

Chicken

Turkey

Lamb

Fish

Eggs

Low-fat cheese

Cottage cheese

Plain yogurt/artificially sweetened

Peanut butter

Beans/legumes

You may also have:

sugar free popsicles

Tea or coffee

Sugar free jello

Broths/buillon

Crystal Light drinks

• If it is not on the list don’t eat it!
  
• Keep a food diary and try to get up to 30 minutes of exercise per day!

Between us I and some friends have seen the scale change within 2 days…some take a little longer but it works!!!

Thanks everyone for the encouragement!

I called today to see if they (Anthem) had received ALL information. The first lady came on rude,,like she didn't like her job. She told me to call another number so I did. That lady acted as if it was her last day and just didn't care...good news is that they did receive it and that it's pending view. Also, while waiting on hold, I heard the information on e-reveiw....what a joke...so i asked the lady about it and she said: I don't know anything about it but I will trans...and that's all I heard because she transfered me so fast it cut off the end of your conversation. I just want to go to the building and start firing rude, over-worked, burnt out employees.........................talk about moody...I had to sleep on the floor last night because my husband would have moved out this morning. i don't know if I should cry or laugh!

If that is not the stalling tactics I encountered I don't know what that is!!!LOL....I feel you Sunrise....that's exactly how I was treated....just be syrupy sweet....you get to them more when you are sweet and happy as sunshine...than when you get angry...

Follow up with them everyday if you have to....

My paperwork went to their coordinator-who makes sure all the required docs are their- well she had sent it to the nurse reviewer and the nurse reviewer sent it back because my psych eval did not have the doc's license number on it...then it became my job to do the coordinator's job and get the psych doc to fax her the info

Now it is back to the nurse reviewers hands...awaiting its turn in line...

so follow up..follow up....don't by shy to call everyday if your gut instinct tells you to!

Now what is up with sleeping on the floor....I don't get it...

he's moving out...or you were so restless you slept on the floor to keep from tossing and turning?..?:smile:

4Jin, At least they have everything they need now. Like you said in an earlier post, if they were going to deny it they probably would have done that a long time ago. It is a stalling tactic to see if you will give up and go away. BC/BS is good at BS. :mad:

Amy, congrats on six pounds.:eek: Every pound you lose now, you won't have to lose after the band and you will be that much closer to your goal. You are doing great! Hang in there with the liquid diet. I've forgotten, do you have a specific brand of liquid you have to use or are you on your own to pick something that is tolerable to you?

thanks for the quick pump me up.....BC/BS for BS they do stand!!