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Pre- Op Insurance Approval Question

SammiSosa

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SammiSosa    0

SammiSosa
Posted

Does anyone have BCBS Anthem how long does it take for approval? My paperwork was submitted today.

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Harsha    168

Harsha
Posted

Following.. I also have BCBS. This Wednesday is my last 6 mo required doctor visit and then they will submit to insurance for approval. I will be so upset if it takes forever or I get denied.

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Chelle Bean    51

Chelle Bean
Posted

Mine took a few weeks but only because all the paper work was not submitted maybe 3 weeks or 4 but I called everyday just about! The insurance company told me that they have to tell you it takes 30 days to get a answer but it shouldn't she said. Good luck

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Jessica Ellison-Correa    66

Jessica Ellison-Correa
Posted

I have anthem and am wondering the same my self ill submit in a few months so I want to know how long it will take as I'm impatient

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SammiSosa    0

SammiSosa
Posted

So I just spoke with the Rep from Anthem and The Drs Office hasn't sent in my paperwork yet Ughhhhh. Also she mentioned that it only takes up to 5 days for approval once they recieve all the required Clinicals. I'm going to give Medstar until Thursday before I become annoying Nanny lol. I really need to know because of my job Smh! This process is so worrisome >_<

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mskittykat03    113

mskittykat03
Posted

I also have Anthem BCBS. My Dr office submitted but they insurance rep didn't like that she had to actually read the Drs notes etc. It was denied when I called (Anthem) they said it was not yet submitted..... But I got the letter in the mail the same day. Grrr. The Dr office resubmitted & called Anthem. They put it through within a day.

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Teapot    26

Teapot
Posted

I have Anthem and while I haven't yet asked for WLS approval, with other things it can be highly variable. It took them nearly 2 months to approve me to get a sleep study. A couple weeks later it took them a couple days to approve a sleep study for my husband. Maddening.

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mskittykat03    113

mskittykat03
Posted

I made sure they covered the wls before I even started. Some policies specifically exclude it! Grr. I think I was lucky, there were no issues. I'm 4 days post op.

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SammiSosa    0

SammiSosa
Posted

Wow that's awesome. Hoping to hear something soon.

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Clarevoyant    347

Clarevoyant
Posted

Ugh sorry. What reason did they give?

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Daenerys Targaryen    109

Daenerys Targaryen
Posted

I was denied today for revision. :(

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.

I am so sorry. My revision surgery was scheduled for yesterday, but insurance denied me too. I had my surgeon do a peer-to-peer phone call, and now insurance is reconsidering the decision (no answer yet). I had to request the peer-to-peer, it was not something my surgeon's office automatically offered. Just an idea if you are looking for a next step.

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middlebeaver    10

middlebeaver
Posted

I was denied because my psych evaluation was not ideal. I knew from the beginning of my visit with this shirk, this wasn't going to go well. She didn't say I should not have the surgery, but it is up to the doctor and patient. Secondly, I paid to have gastric sleeve in 2013, and they felt I didn't stick with it. I lost 70lbs, but that's where it stopped. I don't know what these people want.

I'm filing an appeal ASAP. Obesity help.org has a form to use. Second, I have a new psychological scheduled for tomorrow.

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Daenerys Targaryen    109

Daenerys Targaryen
Posted

I asked my doctor about the peer to peer and they said in their experience it's a waste of time. I wish they would at least try.

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I found out tonight on my insurance's website that my peer-to-peer resulted in another denial, so maybe they are a waste of time. I don't know. I have contacted Lindstrom Obesity Advocacy group to handle my appeals process. Good luck with your appeal!

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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    • KeeWee

      KeeWee

      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
      · 0 replies
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    • Aunty Mamo

      Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
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    • BeanitoDiego

      BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
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    • BeanitoDiego

      BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
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    • ChunkCat

      ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
      · 0 replies
      1. This update has no replies.

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