Insurance approval after setting surgical date?

[jessilou1987 1]

I have completed all my requirements with my program, my pre-op is December 28th, liquid diet starts the 31st and surgery is set for January 14th, but I don’t have insurance approval.... Is this standard practice? I’m confused by this? The coordinator stated she would submit the paperwork to Highmark BCBS PA last week I called they haven’t received it, is this normal? I just am worried I have set up to be off work for two weeks and am planning everything around a surgery date with no insurance approval.....Can anyone let me know if this is normal or how long approval takes? Should I be concerned?

[LadySin 404]

I sooo hate to be the one to tell you (mostly because I sometimes have to tell patients this at work, though for the life of me I don't how they get my number)

That date your Doctor put on the prior auth request form is just a placeholder. Doctor's can't submit paperwork without giving us (your insurance company) some idea on when you want to have it. Once your MD submits the forms your Insurance has up to 14 days from the date that is was received not the date you want to have your surgery (including weekends) to complete that requests.

It's important to keep that in mind. I've had to tell so many patients that just because your Doctor says your surgery is tomorrow, we didn't get the forms until yesterday. So we've got 14 days. BUT (and this is a very big booty) YOU CAN REQUEST THE REVIEW TO BE EXPEDITED!! Your review will be completed with 72 hours!! YOU CAN EVEN REQUEST SURGERY WITHOUT YOUR MD HAVING SUBMITTED ANYTHING!! It's then my job (or rather your insurance) to reach out to your MD and get all the required forms! YES YOU CAN DO THIS YOURSELF! A well kept secret I'm sharing You just have to pretty mush say yes, to all the questions they'll ask you on why you case needs to be expedited. Let them know you're in unmanageable pain or something.

[jessilou1987 1]

Omg thank you so much!!! I’ll call tomorrow! I actually have pseudo tumor cerebri and im at maximum on my meds so I have a legit reason it needs to be expedited! I’m an RN I know all of the medical side but insurance I’m so clueless about! Thank you so much!!!

[LadySin 404]

31 minutes ago, jessilou1987 said:

Omg thank you so much!!! I’ll call tomorrow! I actually have pseudo tumor cerebri and im at maximum on my meds so I have a legit reason it needs to be expedited! I’m an RN I know all of the medical side but insurance I’m so clueless about! Thank you so much!!!

Anytime sis!

[Jazzy1125 1,008]

15 hours ago, LadySin said:

I sooo hate to be the one to tell you (mostly because I sometimes have to tell patients this at work, though for the life of me I don't how they get my number)

That date your Doctor put on the prior auth request form is just a placeholder. Doctor's can't submit paperwork without giving us (your insurance company) some idea on when you want to have it. Once your MD submits the forms your Insurance has up to 14 days from the date that is was received not the date you want to have your surgery (including weekends) to complete that requests.

It's important to keep that in mind. I've had to tell so many patients that just because your Doctor says your surgery is tomorrow, we didn't get the forms until yesterday. So we've got 14 days. BUT (and this is a very big booty) YOU CAN REQUEST THE REVIEW TO BE EXPEDITED!! Your review will be completed with 72 hours!! YOU CAN EVEN REQUEST SURGERY WITHOUT YOUR MD HAVING SUBMITTED ANYTHING!! It's then my job (or rather your insurance) to reach out to your MD and get all the required forms! YES YOU CAN DO THIS YOURSELF! A well kept secret I'm sharing You just have to pretty mush say yes, to all the questions they'll ask you on why you case needs to be expedited. Let them know you're in unmanageable pain or something.

Awesome Job! Above and Beyond... you absolutely went above and beyond with information you did not have to provide.. I totally appreciate you even though it doesn't pertain to me lol.

[LadySin 404]

I just want to teach folks how to navigate a system that doesn't necessarily strive, or go out it's way to work in their favor. ^.^

[mousecat88 2,279]

Yup - this is how they do it. For what it's worth, I have Highmark BCBS and it took them 3 days to get back to the doc with the authorization. Super quick.

Edited December 19, 2018 by mousecat88

[Jenwill630 119]

Glad to read that Highmark only took a few days to decide.

I was submitted yesterday and so now starts my wait......my Dr. office put my surgery date as Jan. 22nd

[jessilou1987 1]

Approved by Highmark PA surgery is officially January 14 on day 5 on my liquid diet!!!!! Sooooo nervous but excited to have a chance to get off some of these meds!!!!

[Jenwill630 119]

1 hour ago, jessilou1987 said:

Approved by Highmark PA surgery is officially January 14 on day 5 on my liquid diet!!!!! Sooooo nervous but excited to have a chance to get off some of these meds!!!!

I got approved this morning.
I am shocked that it only took 2 days.

My surgery is the 29th.

Best of luck to you on yours!!!!!

[jaytissle55 180]

Congrats on surgery date and keep us posted....

[fun_freckles 1]

Anyone else have BCBS TX and know how long it took to get an approval? My case was submitted yesterday to insurance and I am "scheduled" for surgery on Jan 31. I really need to have surgery on Jan 31 though or else I will have to wait until March due to some work obligations.