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Dolphy50
WLSC Member
| Joined: | Sunday October 30th, 2005 |
| Location: | |
| Posts: | 1 |
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Posted: Monday October 31st, 2005 12:34 pm |
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Hello everyone. I was a member over at the msn groups board. Thanks for inviting me over to this one. I have been gone from the board for awhile. Here is a brief update of what has been going on lately.
I was in the middle of doing my 6 month Dr. approved weight loss attempts when I gained 30 lbs. in 2 consecutive months. Well, the drs started to check my thyroid levels. ( I have always had a thyroid issue, first high, now low) Well, to be quick about it...your levels should not be over 5.5, mine were 116. The doctor wonders how I was even functioning w/o being in the hospital. In short, my body had begun to shut down on me. My levels are now down to 9.8, almost normal again!! I have lost from Sept. 20 til today 29 of the lbs. that I gained. Yeah!!
I have to contact my weight loss doctor today to find out what I need to do to appeal my insurance decision to not approve the surgery.
If anyone has gone through the appeal process, could you give me some pointers as to what I am about to go through.
Thanks,
Amy
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Melissa Parish
Administrator
| Joined: | Saturday October 22nd, 2005 |
| Location: | Tampa, Florida USA |
| Posts: | 1263 |
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Posted: Monday October 31st, 2005 02:13 pm |
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Hi Amy:
This topic is another important one so we've made a special forum for it as well. Thanks for bringing this up.
Some of the insurance companies seem to be getting more and more difficult on issues related to weight loss surgery. It is SO important that all of us (pre-op and post-op) join groups like the OAC (http://www.obesityaction.org) to include our voices in the goal to educate and legislate regarding WLS.
You post-op's, don't forget to write your insurance companies and tell them the benefits you've seen! Write your legislators as well. Just because we got what we wanted doesn't mean we should stop. Our letters and actions will help others just like Amy, fighting the process. Don't you wish someone had done the same for all of us? Let's speak up and show that this is lifesaving, very worthwhile, process and we (as a group) won't be ignored.
Amy, we hope someone will post and give you some guidance. We're so happy to hear the thyroid issue is in check now. We're holding positive thoughts for you on the insurance process.
Melissa & Dan
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Mom2Four
WLSC Member
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Posted: Monday November 21st, 2005 03:28 pm |
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Does anyone who had WLS have BCBS Fed. insurance. I was wondering how long it takes to get approval/or not. They say less than two weeks, just wondering if anyone has had WLS under this plan. Thanks 
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jeaneam
WLSC Member
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Posted: Monday November 21st, 2005 11:05 pm |
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My approval with BCBS Fed was done in less than 2 weeks. Also, I did not have to show a 6 month supervised diet as well. Good luck!
Jeanea
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Mom2Four
WLSC Member
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Posted: Tuesday November 22nd, 2005 03:07 pm |
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| oh thank you, thank you!!! Thats what they told me, can't wait for a date!!
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amyboo35
WLSC Member
| Joined: | Friday October 3rd, 2008 |
| Location: | Texas USA |
| Posts: | 51 |
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Posted: Friday October 3rd, 2008 11:01 pm |
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Hi well I have BCBS of MN which is different from the federal plan and I have to go through the 6 months of medically supervised diet but from what I have heard the approval process is usually done within 2 weeks. Depends alot on your surgeons office. Mine seems to be every aggresive in getting what they need to get things done. If they are not in any hurry then things will sit on their desk for a while b-4 someone realizes. Good luck! Hugs!
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Melissa Parish
Administrator
| Joined: | Saturday October 22nd, 2005 |
| Location: | Tampa, Florida USA |
| Posts: | 1263 |
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Posted: Friday October 3rd, 2008 11:44 pm |
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Most insurance companies, now, require the 6 months supervised weight loss attempts. There are a few out there that don't, but it seems to be the overwhelming majority that do. It's always worth a simple phone call to ask in case you need to get started right away and maximize the time of your wait.
-Melissa & Dan
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salinas699
WLSC Member
| Joined: | Monday February 2nd, 2009 |
| Location: | |
| Posts: | 2 |
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Posted: Tuesday February 3rd, 2009 01:25 am |
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Hi there. I am new here (1st time visitor). I have BCBS of Massachusetts (even though I live in OR). My surgeon's office jut received my insurance verification, and my insurance doesn't require the 6 month DR supervised diet. But I am curious if I will get and answer for the authorization in 2 weeks. Anyone have my insurance?
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kimd
WLSC Member
| Joined: | Saturday February 14th, 2009 |
| Location: | |
| Posts: | 3 |
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Posted: Tuesday April 14th, 2009 01:02 am |
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I have BCBS of MA, and right now I'm getting the run around. My doctor submitted approval paperwork on 3/14 and somehow the paperwork "wasn't in the system" for my 5 calls to find out until 4/10 when the doctor's office finally called about it. This morning they told me it was still "in process" because my doctor didn't provide a surgery date. Well, of course I don't have a date because it hasn't been approved. This afternoon I called again to find out if they had gotten any further. I was on hold for 20 minutes while the woman looked up the wrong information, and just enough time for the department she needed to close. I was very close to tears this afternoon because tomorrow was the original date we had planned.
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Melissa Parish
Administrator
| Joined: | Saturday October 22nd, 2005 |
| Location: | Tampa, Florida USA |
| Posts: | 1263 |
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Posted: Tuesday April 14th, 2009 01:28 am |
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Hi Kim:
We're so sorry to hear how frustrated you are. We can tell you, most surgeon's do give a tentative surgery date when they submit the insurance papers. Of course, they know they may have to change the date. It's all a paperwork game. You were so right to keep following up! So many aren't proactive in following up and then end up even more disappointed when weeks and weeks have gone by that they didn't check. At least you've stayed on top of it.
We know it doesn't help but we are true believers that everything happens for a reason. Maybe a delay happens because it's a better time for you to have your surgery or a better time for the surgeon to operate. Or maybe getting you just that much more prepared. Again, we know it doesn't make it any easier or less frustrating though. Just hang in there though. At least it is still in the works and you ARE still on the path to having your surgery. In the meantime, make the most of the extra time and get to know everyone here and start preparing things for when you do go in for surgery. It's the perfect time to be cleaning out pantry and fridge and stocking up on samples of water and protein supplements and things you'll want or need after surgery. It's a great time to decide what you'll want to take to the hospital, etc. You'll be so prepared by the time you have your surgery that it'll be a stress free process AND you'll have your own cheering section right here too. :0)
-Melissa & Dan
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kimd
WLSC Member
| Joined: | Saturday February 14th, 2009 |
| Location: | |
| Posts: | 3 |
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Posted: Thursday April 16th, 2009 02:09 am |
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| I took the squeaky wheel gets the grease approach and it actually worked. I called BCBS MA every day at 8:30 and talked to a customer service rep who then had to consult with the inpatient coordination department. When it became clear that things weren't moving, I started calling twice a day, once at 8:30 am and then again at 3:30 pm. After three days, the insurance company actually called the doctor to get the thing finalized! I was given a surgery date today - 4/28!
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Melissa Parish
Administrator
| Joined: | Saturday October 22nd, 2005 |
| Location: | Tampa, Florida USA |
| Posts: | 1263 |
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Posted: Thursday April 16th, 2009 03:17 pm |
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What great news! Being proactive pays off yet again. Good for you!
-Melissa & Dan
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