Ridiculously long time waiting for insurance approval

[bunyip 27]

Hello, I've been lurking for a few months now, and this is my first post. I apologize in advance for the long diatribe.

Has anyone else had a problem with their insurance company dragging their feet to delay approving their surgery before the end of the year? My doctor's office faxed in the information to my insurance company on 12/8. On Friday, 12/10, I called the number on the back of my insurance card, went through the voice menu, and was finally connected with a woman who advised me that they hadn't received any request for preop authorization for me, but she said that if it had been faxed that they might not have gotten all the requests off the fax yet. She told me that they should have it by the following Monday. I called again on Monday and was again told that they hadn't gotten any preop authorization request for me. I called the doctor's office and spoke with the lady who does all the insurance submittals. She told me that she'd spoken to the insurance company that day and was told that my paperwork was under review. So, I waited another two days and called the insurance company again. Again, I was told they couldn't find any requests for me, and again the doctor's office said they were told it was still under review.

Fast forward two more days to last Friday. I call once again, and this time, the lady I talked to told me that they had gotten the request but there were no insurance codes on it and that it would not be reviewed until they got the codes. If there weren't any codes on it, why was the doctor's office told multiple times that it was under review? And if there was some problem with the codes, why did no one tell the doctor's office about it when they called to check on it? I called the doctor's office again, and the insurance lady re-faxed the same request she sent originally. She told me that all the codes were on the paperwork she sent the first time. I believe her. That is her job, and she does it all day, five days a week. She knows what she's doing.

Okay, so today, 12/21, the doctor's office called to tell me that the insurance company told them this morning that my case was still "under review". I call the same number I've been calling all along and get the same old story that she can't find any requests for me. She then wants to know if I'm calling about a pre-certification or an authorization. I told her I was calling the number on the back of my card (the only number listed for preop authorizations), and she then tells me that another department handles that. Again, if that were the case, why was I only told that on the fifth call I made? She transfers me to the other department, and the lady there does some checking and then tells me that the first two pages (which contain the insurance codes) were missing from the first fax that was sent to them but that they got the missing codes last Friday. Again, the cover sheet says how many pages were sent. If they didnt' get all the pages, they could have told the doctor's office when they called to check on the progress. And again, how could it be "under review" if they were missing paperwork?

Now, of course, it's too late for me to get my surgery done before the end of the year. It seems pretty obvious to me that the delay was intentional because I've already paid my deductible and out-of-pocket for this year, and I wouldn't have had to pay anything other than the extra charge for my assisting surgeon who isn't in the insurance network. The really ironic part is that I wouldn't have known anything about having met my deductible and out of pocket if the insurance company hadn't told me that when I called to check on my surgery benefits back in September.

Has anyone else run into anything like this?

[Miss Mac 6,261]

It sounds like a stalling tactic to me. My packet was sent to BCBS Federal Employee on Thursday 11/21/2013 and was approved by noon on 11/25/2013 on; two business days. I had my surgery on 12/23/2013 just before the end of the year.

[Pinkgirl1234 761]

Sounds like your doctor's office is not on top of it as you think.Missing codes or a request for more information is sometimes required.Call or go visit the dr office and speak with the administrator.Let her make a call to the insurance company while you wait in office....I had to be relentless...I kept on everyone's butt...

[Djmohr 6,965]

Sounds like both parties are off their game but certainly the insurance company is messed up big time.

My info was faxed by the doctors office in the am and by 1pm same day I was approved and surgery was scheduled.

I will say that happened on,y after my doctors office screwed up. They sat on my paperwork for 2 weeks before I called to check only to find out they screwed up.

Maybe they were able to get it pushed along somehow. Not sure.

[bunyip 27]

djmohr, I have BCBS Oklahoma. I've had a few surgeries in the past, and never have I had this kind of trouble getting approval. It just took a day or two, and it was done. I just think it's suspicious that i kept getting different stories while the insurance company just kept telling the doctor's office it was "under review".

I have no doubt they'll approve it pretty quickly now that the surgery can't take place any sooner than next month. New year, new deductibles.

[ssflbelle 829]

Hello, I've been lurking for a few months now, and this is my first post. I apologize in advance for the long diatribe.

Has anyone else had a problem with their insurance company dragging their feet to delay approving their surgery before the end of the year? My doctor's office faxed in the information to my insurance company on 12/8. On Friday, 12/10, I called the number on the back of my insurance card, went through the voice menu, and was finally connected with a woman who advised me that they hadn't received any request for preop authorization for me, but she said that if it had been faxed that they might not have gotten all the requests off the fax yet. She told me that they should have it by the following Monday. I called again on Monday and was again told that they hadn't gotten any preop authorization request for me. I called the doctor's office and spoke with the lady who does all the insurance submittals. She told me that she'd spoken to the insurance company that day and was told that my paperwork was under review. So, I waited another two days and called the insurance company again. Again, I was told they couldn't find any requests for me, and again the doctor's office said they were told it was still under review.

Fast forward two more days to last Friday. I call once again, and this time, the lady I talked to told me that they had gotten the request but there were no insurance codes on it and that it would not be reviewed until they got the codes. If there weren't any codes on it, why was the doctor's office told multiple times that it was under review? And if there was some problem with the codes, why did no one tell the doctor's office about it when they called to check on it? I called the doctor's office again, and the insurance lady re-faxed the same request she sent originally. She told me that all the codes were on the paperwork she sent the first time. I believe her. That is her job, and she does it all day, five days a week. She knows what she's doing.

Okay, so today, 12/21, the doctor's office called to tell me that the insurance company told them this morning that my case was still "under review". I call the same number I've been calling all along and get the same old story that she can't find any requests for me. She then wants to know if I'm calling about a pre-certification or an authorization. I told her I was calling the number on the back of my card (the only number listed for preop authorizations), and she then tells me that another department handles that. Again, if that were the case, why was I only told that on the fifth call I made? She transfers me to the other department, and the lady there does some checking and then tells me that the first two pages (which contain the insurance codes) were missing from the first fax that was sent to them but that they got the missing codes last Friday. Again, the cover sheet says how many pages were sent. If they didnt' get all the pages, they could have told the doctor's office when they called to check on the progress. And again, how could it be "under review" if they were missing paperwork?

Now, of course, it's too late for me to get my surgery done before the end of the year. It seems pretty obvious to me that the delay was intentional because I've already paid my deductible and out-of-pocket for this year, and I wouldn't have had to pay anything other than the extra charge for my assisting surgeon who isn't in the insurance network. The really ironic part is that I wouldn't have known anything about having met my deductible and out of pocket if the insurance company hadn't told me that when I called to check on my surgery benefits back in September.

Has anyone else run into anything like this?

I haven't been having these same issues but I have also been waiting since Nov 23 for a surgery date so I have some idea how you are feeling. My paperwork was submitted before I had medical clearance from my PCP. My PCP will not give me medical clearance until he has a surgery date and my surgeon will not give me a date until I have medical clearance. I have been calling this my Catch 22. When I saw my PCP again on Thursday he told me he would sign the clearance and he still has not. I called again today and the Office manager was not in but the office worker took the message and I also have the surgeon's record lady working on it too. At the rate this is going I probably willnot have my surgery until Feb as the surgeon only operates 8 days a month. VERY FRUSTRATING-and will COST Me more as well.

All I can say is just keep on pushing them as I am doing.

[Kelly0559 34]

I had issues with my insurance company too. It took over a month to get approved and I was approved literally a week and a half before my surgery was scheduled to happen. They cut it really close. I had all requirements that my insurance company required completed but they kept coming back with little things that they said I needed to do. It was beyond frustrating and annoying but I didn't give up and finally for it approved. Unfortunately for many insurance companies, they make you jump through a billion hoops but stick with it. Just keep coming back with the stupid stuff they ask for and they will eventually approve it. I feel for you though, hang in there!

[Pinkgirl1234 761]

Yes indeed...you have to jump through hoops and then wait..my doctors office knew this and pre scheduled me while I was awaiting approval.It took them 3 weeks ...and I had already started the pre op diet before I got the call that I was approved.

Also I think the insurances work with the hospitals in knowing how many patients they are capable of handling in a month....They make a conscious effort to delay many cutting it close...end of year procedures...Quotas...

[ssflbelle 829]

Seven days later then my last posting and I still do not have a date. The surgeon's office called today to tell me they do not have the EKG report even though that was done Nov 12th. I'd like to know why it take 6 1/2 weeks to send a medical record from one Dr to another? This is ridiculous!! I just went through another phone call session with the site manager at my PCP office too as he hasn't given me medical clearance yet either despite him saying on on Dec 17 he would. I have been on everyone's a$$ at least 2 to 3 times a week trying to get this surgery done and on top of it I also need my gallbladder taken out.

[ssflbelle 829]

4:36 this afternoon I was finally told that the surgeon had finally received everything from the PCP and I have a surgery date of Jan 26th. It took a ridiculously long time for the PCP to give clearance. I hope you get your clearance soon and your stress level comes down like mine did.