Insurance approval??

June 16, 2000

Hi guys... I just talked to my insurance company and was wondering if any of

you can tell me what (if anything) this means... I called my insurance co.

this Monday to make sure they had my prior authorization letter. To my

surprise, they did have it, and the girl told me to call back Wed. and I

should have an answer. I did call Wed, and Thurs, and today. Until today,

they kept saying it was still under review. Today, the girl told me at first

that the letter Dr. R sent was a letter for PRE CERTIFICATION, not PRIOR

AUTHORIZATION... she said he was telling them I was having it done, not

asking for permission from them. This is the same letter that I have that

says clearly that the thing they want is to obtain pre-authorization... In my

book, pre and prior authorization mean the same thing. She said they would

need a different letter from Dr. R, but then she told me to hold on while she

checked something. I think she must have looked at the letter and figured

out that it was the right letter. Anyway, she put me on hold for a long

time, and came back and told me my case had been closed until they received

more info from Dr. R. She told me they can't approve it until they receive

a psych profile, and a nutritional counseling note. Do you think this means

they are going to approve it? I hate to get my hopes up, but that's kind of

how I took it. Or maybe they won't even review it until they have that? My

ins. is BCBS of MI. Anyone who has had this happen to them, please let me

know what happened. I would really appreciate that!!

Thanks alot!!

Debbie in IL

MGB wannabe

June 16, 2000

Bummer.. I was sort of hoping that was a good sign, she sort of made it sound

like they would approve it if Dr. R sent them the info they wanted. I am

trying not to get my hopes up too much, but I want this so bad, and I really

can't afford to self pay. I saw my PCP yesterday, a real sweetheart, and he

asked me if I was getting excited, or nervous. I said mostly excited, but a

little nervous. I told him about , and he said he thinks I will do

fine. I wanted to tell him I'm more nervous about getting insurance approval

than the surgery. That is sad, when you are more worried about someone

paying than having surgery. Oh, and I don't have BCBS of MI, it's BCBS of

MN, sorry about that, typo. So, I'm hoping to hear something soon! Good

luck to you and everyone else, let me know what happens, ok?

Deb in IL

June 16, 2000

Hi,

So you can't have thyroid problems??????

Regards,

Debbie in IL

In a message dated 6/16/00 5:48:22 PM Pacific Daylight Time,

cmsm97@... writes:

<< Hi Debbie -

I have Oxford Health Plans, and they made me get a psychological review and

meet with a nutrional counselor also before approving. (And they made me get

a blood test showing no thyroid problems.) I called a surgical center near

me that also does gastric bypass surgery who was listed in my plan, and they

had a certified social worker and a nutritional counselor on staff so I made

appointments with them and explained that I was going for ANOTHER kind of

bariatric surgery with a faster recovery time, ect., ect., They gave me

copies of their evaluations about a week later, but I had to ask my PCP to

call them and tell them to hand them over! Then my PCP had to prescribe the

blood test for a thyroid scan. So all in all the whole process took me almost

three weeks. Once I faxed all of the above over to both Oxford and Dr. R's

office - the insurance co. approved me within 48 hours, and I had my surgery