Insurance approval

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WenchLori
WenchLori Member Posts: 1,558
edited May 2016 in Employment, Insurance, and Other Financial Issues

Good morning,

I saw my plastic surgeon last Monday, I was told they'd have my insurance approval in just a few days. It's been a week and my insurance still has not approved my reconstructive surgery. Everything had been moving so quickly with all appoinments up until this. It feels like someone has slammed on the breaks... Has anyone else have to wait weeks for the insurance to approve your procedure?

I'm getting antsy!


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  • Momof6littles
    Momof6littles Member Posts: 184
    edited April 2016

    Call your insurance company to find out what the hold up is. I have had it happen that someone missed the ball on the referral process. Call the doctor to prompt the sending of the referral paperwork. I have had this happen with my referral for genetic testing. The doctors office supposedly was sending the referral, but hadn't yet. Be the fire under their behinds.

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  • fifthyear
    fifthyear Member Posts: 225
    edited April 2016

    Call them, and also call the doctor office and ask them to call the insurance office. It may help. Good luck, hope you hear good news from them soon.

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  • rainnyc
    rainnyc Member Posts: 1,289
    edited April 2016

    You can also ask the insurance company for a case manager. They're people who work for the insurer and are assigned to those with complex medical issues. Both the case managers I've had--for two separate insurers--have helped a lot in cutting through red tape.

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  • WenchLori
    WenchLori Member Posts: 1,558
    edited April 2016

    Thank you all for your advice... I've got the fire started, I think?! I'm going to do all of the above plus call my primary care manager and have her get into the fight with me. Jennifer may not be able to deal directly with the plastic surgeons office but she'll call the insurance company relentlessly! She has fought the insurance company on all other appointments and I'm sure she will fight to help get this taken care of also. I was hoping I wouldn't have to ask her but I have her on speed dial, per her request and she's the only one that has called me daily to let me know where we were in the approval process. I'm not sure why I didn't think of her sooner?

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  • WenchLori
    WenchLori Member Posts: 1,558
    edited April 2016

    Ok, I've called the PS office and the person that files for insurance is in surgery with a patient, their office staff participates in surgery also? Is this normal or should I start looking for another PS? Any how, I was asked to call back after 3pm. My second call was to my insurance company and SURPRISE! My PS office hasn't even sent the request for my procedure! I'm beyond POed right now, what is wrong with them?! I've registered with my insurance co so I can go online and check into the progress of all request and any other procedures recommended from any of my doctors. I'm hoping I can get my head together before I make the call to the PS! I will keep you posted.

    Angry in Indiana!

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  • WenchLori
    WenchLori Member Posts: 1,558
    edited April 2016

    Update on insurance...

    After almost 3 weeks of going back and forth with my insurance company they have finally approved my reconstuctive surgery during and then anything I may need after my cancer surgery. I'll call and make the appointment with my PS on Momday...

    I thought it would be a relief but now I'm getting very nervous!

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  • WenchLori
    WenchLori Member Posts: 1,558
    edited May 2016

    After closer reveiw of codes entered for insurance, my PS has not gotten approval from my insurance yet! I was almost there!

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  • cbowle
    cbowle Member Posts: 55
    edited May 2016

    Hang in there WenchLori! Sometimes insurance companies take a while. I haven't had much experience with the breast surgeryyet but years ago it took them several months before they approved an eye surgery for my son.

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  • WenchLori
    WenchLori Member Posts: 1,558
    edited May 2016

    Thank you Cbowle for the much needed encouragement! Several months to approve eye surgery for a child?! I hope all went well and your son is 100% recovered :) It's still mind boggling how long it takes to approve procedures BUT don't be late on your premium payments... their called premiums for a reason.

    I'll continue to wait very impatiently!

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  • WenchLori
    WenchLori Member Posts: 1,558
    edited May 2016

    I just talked with my BS office we are waiting on her being approved but at least now I have a tentative surgery date of 6/15/2016. I sure do hope my IDC hasn't spread by then. If a cancelation comes up with my PS I'll be moved up into that time slot. We are moving forward FINALLY ;-)

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  • WenchLori
    WenchLori Member Posts: 1,558
    edited May 2016

    It's offical! My PS and BS have offically been approved finally! Surgery date is June 15 at 8:30 am!

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  • vlnrph
    vlnrph Member Posts: 1,632
    edited May 2016

    Good job! So nice to be able to focus on a date and have a plan. With triple negative, is chemo in your future?

    Just to mention, a well known national company kept telling my husband they had not rec'd certain information from the provider. This may be a delay tactic. We sent a fax of the required paperwork to a specific person at the insurance and required them to respond back in order to prove submission. Don't always believe what the "customer service" representative tells you (their computer may not show issues being held for review so it can look like a claim was not filed), ask to speak with a supervisor for confirmation.

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  • JessieJake
    JessieJake Member Posts: 233
    edited May 2016

    Oh WenchLori, so glad you got that straightened out. UGH, just the thought of going round and round with insurance is enough to make you ill.

    I was just thinking about my own approval process this morning prior to reading your situation. I learned in my process that reconstruction was automatically approved by law if mastectomy was approved. I just was looking online about this and found it varies by state. My state happens to have a pretty well defined plan and I guess I benefited. Despite that part being easy it took several phone calls over a few days to convince the clinic that my insurance plan DID indeed require pre approval. They kept saying it didn't and simply wouldn't submit the request to the insurance company. Although we shouldn't have had to do it, my DH finally conferenced the clinic and and insurance company together on a phone call. Then, viola, it was easy from there. Crazy. Good luck on June 15th and hopefully no more paperwork worries!

    In case you are curious, here's a link that explains the laws of reconstruction :) by state:

    http://www.plasticsurgery.org/reconstructive-proce...

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