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Waiting

I went for my first doctor's appointment 2 1/2 weeks ago. Should I contact them to see if they have heard from the insurance company or should I wait until I hear from the insurance company? I have 2 insurances and I know my primary will not cover the lapband. I think my secondary might if I qualify but we have to wait until the primary sends a rejection before we can submit to the secondary.

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I contacted my insurance company directly at least once a week. Just keep them on their toes. Good Luck!

Yeah, I absolutely agree that you should call your insurance company. Be nice, and just say you're calling to see if the file is complete on your request for precertification. In lots of cases delays are caused because someone needed one more piece of information, sent a request out and it got lost or ignored. It's VERY important to chase down all those little details yourself, because no one cares as much as you do. Call! :D

I think what Alex said holds true for everything these days. Nothing gets solved any more with just one phone call. Sometimes you can call every day with no results, just to find out on day 5 that the file hasn't even been reviewed yet. Call today. Call often. The squeaky wheel gets the oil.

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I contacted my insurance company and I had to call them 3 times (in one day) before they found the paperwork. Luckily my doctor sends everything with a signed receipt so they knew the insurance company received it. They said it still takes up to 30 days even though they know they do not cover weight loss surgery. You would think they could just stamp it "no" and send it back so I could file with my secondary insurance. Boy, if we were as slow paying the premiums as they are responding we would sure hear about it.

I had the same situation with my first try, okiejudy. I knew I was going to get a denial and no one could understand why I WANTED that denial quickly. If you already know it's a done deal maybe someone there could actually get it done faster for you. When I went through this I had to pester my doc's office to submit but once they did I had the denial in hand in about two days. It might be worth another phone call if you didn't make it clear in your earlier calls that you KNOW it's going to be denied and that's what you WANT to see. They might think they're being kind by telling you it will take 30 days. :rolleyes

  • Author

My doctor's office is pretty good. They sent the predetermination 6 days after my office visit. I think the hold up is going to be getting the denial then sending it to the secondary insurance company. I am going to call the insurance company again next week. It shouldn't take 30 days for them to send a denial letter.

I would keep after the insurance company. 30 days seems like a long time to get a no, especially when the insurance co already knows they are going to deny it. Good luck with your secondary insurance company.

  • Author

Well I received word from my primary insurance that they will not pay for the lapband. Now we just have to send it to the secondary insurance to see if they will pay. Keep me in your prayers.

  • Author

I just received word from my doctor's office that they received the rejection from my primary and now they will file with my secondary. They seem hopeful that United Healthcare will approve it. Keep praying.

  • 5 weeks later...

I heard that United healthcare is one of the easiest insurances to get approval. I already talked to someone there and if the criteria is met, they will probably okay it. Diana

  • Author

I went for my first doctor's appt. on March 1 and I am still waiting to hear from my secondary insurance to see if they will cover the surgery. One thing that has slowed it down was the doctor's office failed to send them the decline from my primary insurance carrier. So then they faxed it to them and the 30 days counting started all over. I think I will call the insurance company tomorrow to make sure they haven't lost it.

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