4jin

ok....so I got to thinking..... submitted on 12/17/07... regular calendar days it has been 26 days since submitted(excluding xmas eve and xmas and newyears day). Business days it has been 18 days (excluding weekends, xmas eve, xmas and newyears day). Does anyone know which one should I be keeping track of...?!

that is so sweet of you. thanks... Just think of my perseverance just to get an approval and that should help you a bit when you feel weak and need the motivation to keep on the liquid diet...LOL... My surgeon & dietician suggested some but can substitute until I find the one I really like. I have tried GNC isopure low carb...pretty decent if you add some vanilla extract...unjury is pretty good and the Adkins Advantage are as well. Slimfast make me too hungry after an hour of drinking them..I think it is the sugar content in them. Excellent 6lbs down!!! You are off to a better than great start....! I appreciate you all for sticking around with me for an answer from the insurance(praying it is an approval)...well when is it 30 days...I submitted on 12/17/07....calendar days almost at 30 business days because of holidays I think 15 or 16...darn...

how's everyone doing? BC/BS of GA is going to drive me insane!!!! this waiting game is ridiculous.

Thanks StLouisGal, I called the insurance this morning. She received the fax from the psychologist. Info was forwarded to the nurse reviewer again and it is back in her hands again. She assured me there isn't anything else that has been asked for or that is needed. It is all a waiting game. I can't speak to her...it su$k$!!!!!! All I can do is wait for the surgeon's office to call me with info once the isurance company calls them. ain't that some major BS if you ever heard any for stalling?! But I am still hoping that it is within approval guidelines within the next couple of days...darn BC/BS of Georgia!....

:smile:Welcome Sunrise, thanks for the support. as you can see these thread has been excellent support for me. The friends and support I have made here are unbelievable. AmyMT, StLouisGal, sghatl, motorcrossgirly, WaSabubblebutt, Chrisann, tweety63, Cynthia, among many other special friends have been my pillar throughout this process. I have learned so much from these folks. We are here for support. As you can see when people reply and suggest our share the same experience at the same time is what makes it priceless. What I am saying is don't be shy. Don't worry about being mean or evil. Be it, want it, say it and most definitely do it! go for yours!! no one else is going to do it for you! As you may have read my battle has been a fencing war with my insurance...but hopefully I will be at the other side and this will just be an experience to share with others and smile about down the road. Persistence...persistence...

i am so depressed and upset right now.... TOM must be around the corner because I normally am not this emotional....

Ok guys I called my HR's benefits help center line. Spoke with a benefits specialist who connected me with a benefits coordinator...who wasted my time and his time. He said they have no weight on the decision made by the insurance company for the prior approvals. Made me so mad....waste of time... I said reminds me we have a new chief in town and not the old employer we all loved because people are sure acting like it..... I said..oh...thanks for wasting our times....I will be proceeding with an appeals attorney when I receive a denial letter once they are done playing the stalling game-as by law they are required to give me their decision within 30 days..and that will be soon. and then I hung up... ....uuuuuuuugggggggghhhhh!!!!!!!!!! Leave it to me to have the tough journey.....why?...why?....

I wish I had that kind of approval and I am just a hip jump skip away in GA with BC/BS

well guys the doctor called me himself personally. He can't believe they are holding me back for that. He apologized for the number not being on there. He still couldn't believe as he says he does lots of reports for many insurances especially BC/BS. I said just another bump in the road that needs demolished to move on....he took the insurance rep's/nurse reviewer info and said will fax himself today. He said to call him on Monday before noon if they claim did not receive or if I need anything from him and gave me his personal cell#. Now it is back to waiting until Monday to call the insurance company to check they received it. In the meantime I am going to contact my HR benefits coordinator with an attempt to receive help to get this thru.. we'll post update..

Ok just as I suspected...all we have is an 1-877 number for our benefits center. There is no person here that can help....I am on my own.

Not sure...I work for a huge corporation I don't know if our benefits coordinator is even here in this same state or not. but I will give it a try... I just got off the phone with the psych office. she is paging the psch to check his voicemail ASAP and sent my tel#. She said he just has to go in and edit the report and add his lic # and can only be done by him. I explained to her that is the hold up with my approval. She understood and said I should be called back and handled today ASAP. You bet I am going to follow up with them at noon if I don't hear back. Going to go ask about our benefits coordinator now... thanks guys

ok its not working I am going to have a mad-evil breakdown...and I am starting to take it on my co-workers....sorry.. I got anger issues to begin with-with BC/BS....now I am just seeing steam come out of me.:eek::mad::mad:

I called...and after 35 minutes calling..and calling...i finally spoke to the same rep is spoke to on 1/8/07. She said she called the psych office and left a message, but did not receive a call back. She said she got the letter I sent with the license number but she can't do anything with that it has to either come from the psych doctor or from my surgeon's office. I have been calling both this morning to no avail. Left messages. Called again to the psych office-left message for her to call me back....left message to the medical coordinator at my doc's office as well. I am going to wait until 11:30for a call back. I will then start aggressively calling both offices. But my surgeon's office can't do anything as I am sure they received the same report I did-without the license. I looked at mine last night and it was missing the lic #. (taking deep breaths) to calm my anger down....

thanks ChrisAnn, how are your incisions doing?

Just got home from school. I am going to relax with the DH. Make him rub my head or something. And later pray before i get to bed that tmw I do receive good news. Good Night and God Bless.

I have BC/BS. My info was sent on 12/17/07. I began calling them on 12/19/07 just to make sure they received the faxed documents. Yes they did, I was told to call back 12/27 I waited and called back on 12/28/07. I was told that person handling was out for the holidays to try calling back on 1/2/08. I again waited patiently and called on 1/3/08. On 1/3/08 was told it was pending still for review. I said what does that mean....being reviewed..partially reviewed...what? she said it has not completed reviewed yet to call early next week like on 1/7/08. So I got mad..but mainted calm and nice on the phone....on 1/7/08...various just plain dumb reps gave different answers-not in system, what doctor, when was it submitted-got transfd over and over and then always ended up on a machine to leave a voice mail. Left like 4 voicemails. On 1/8/08 I began calling early was feeling like crying at that point and then like taking the phone and throwing it against the glass window...but I regained composure.... I called and called until I finally got a competent rep who actually listened to what I had to say. I got persistent because I received the fear like I was going to get a denial because the last three reps during the conversation asked for my mailing address to "verify" it....whatever...I finally got transferred to the live person handling my case....I even thanked her@!!! She said my hold up was my psychologist did not include his License number in his eval...what the f****!!!!! She said she would handle it for me to call her back this Friday and gave me her extention number. I called the psych got the license number...typed up a letter put the number on it and faxed it to the rep. Now I am a walking zombie waiting for Friday afternoon so I can give her a call and hear the decision.... My point....please be persistent with the insurance company...so what if they start to see you as a pain in the buttocks... you have every right to be!! but I was always really nice everytime I called--just aggressive I call it passive aggressive...hehe...LOL

AmyMT, CONGRATS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! OMG.........your surgery is a couple of nights and wakes away!!!!!WOW!!!! Two approved in 2 days!!!!!!!!!!! Thanks Amy for keeping me in your prayers.....I really appreciate and thank God for everyones support.

StLouisGal thanks that means alot to me. Let us now when you get your date....as then you will need safe prayers and good healing vibes your way.3 Congrats CynthiaMcc! I could not sleep soundly last night....All I kept thinking in the back of my mind...is it Friday....and just like groundhog day where it never made it to Friday...LOL.. terrible isn't.....?

YEEESSSSS.....YIPEEEE..... on the plane to surgery you go!!!!!! :fencing: StLouisGal awesome!!! You won the fight with the insurance!!! Way to go!!! I just pray I get the same news on Friday!!!

thanks guys, after much consideration, and word from friends here on lapband I have decided to wait it out until Friday. I called the psychologists office and spoke with the medical biller, and she gave me his license number. I wrote it down. And I am going to wait until Friday when I speak with the insurance company again. Then I will provide the information if necessary...after all my insurance prior-approved consultation with him as in-network provider...if he is not licensed it is their responsibility and issue not mine... AmyMT I feel you on the crankiness....boy do I ever... I am a bit more calm today... StLouisGal is in on the same train express as we are..... promises to know within the next couple of days.

exactly my thoughts.... errrrrghghghh.......

I don't want to say it but.....everyone cover your ears.. StLouisGal...you must lie...no other option....give them a date...tell them your surgeon needs to have the approval in the file, hospital surgery date is set....just pick a date..I would say...10-14 days from now...I go for it...call her back...say it is scheduled for January 2X, 2008. OR is reserved and everything is set. Clear liquid diet starts on January 2X,2008 to clear me for surgery. Lets play their hardball chess game.... check....your move insurance... then when you hang up we both need the next morning to fast in order to ask for forgiveness from GOD for the lie.

that's terrible to require someone that....but jumping...jumping..through the hoops...we go... I even thought about paying for the surgery myself...but then again..that is exactly what they are looking for....to weed out the non-persistent.... no way....UNITED WE STAND!!

Anyone know of a good psychologist? It seems that the one I went to might not be licensed...? Oh...in Georgia...North Atlanta area please?!

UPDATE!!! Might be a long post...sorry Ok so I called the insurance company back yesterday about 2 more times..each time...lots of transfers...and ended up in the same spot...an answering machine everyone assisting other customers..... did some online searching last night...found the prior approval tel number for georgia...called it this morning...lines busy.... called the other number I was previously calling....no luck....rep didn't even attempt to listen to me....asked me same question 3 times and differrent times on the call...:rofl: finished with her...."no there is no phone number for the prior approval dept" she said... ha!!! I refused to give in today....very fustrated in a private office at work....I was venting alone...:angry:angry Decided you know what....I am going to be passive aggressive.. called back the number I found on the internet last night.... spoke to a rep who was lots of help (but everyone kept putting me on hold)(had the feeling something was there that they did not want to say) but I held....kind of joked with her and thanked her for being the first person to listen...she transferred me to a live person in prior approval....I was flabbergasted.....OMG:omg: The rep I spoke to was very helpful....she said call back this FRIDAY....ouch..... I am praying ..praying every chance I get from now to Friday..... She mentioned get this....my psych eval looked to be the hold up.... the psychologist did not put his license number in the report and he is not found as a licensed practitioner...say what!!!! BCBS behavioral services approved him as in-network and covered the eval....so I look at my copies...and there it is NOT there his flippin' license number DARN!!! How am I suppose to look at that....But she told me not to worry she will be calling the psychologists office and my doctors office herself to get things clarified. Other than that nothing else noted. I am so mad right now....my surgeon's office suggested that flippin' psychologist in the packet they provide to everyone...can you imagine how many people are probably having problems....errrrggggghhh,. what should I do...should I go do another psych eval? aaawwwwaawww