Guest guest Posted June 16, 2000 Report Share Posted 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 16, 2000 Report Share Posted 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 16, 2000 Report Share Posted 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 16, 2000 Report Share Posted 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 date 24 hours after that. Hope this helps....good luck! M. MGB 6/7/00 Subject: Insurance approval?? >>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>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 16, 2000 Report Share Posted June 16, 2000 Hi, This is just my opinion, and my daughter is not yet approved by Cigna, but I WOULD NOT let the insurance company determine which surgery is best for you. I would send them the info, showing strongly and definitively why the MGB is FAR superior. Don't let them be in control of your body. I would not even go see that Dr, as I DO NOT want that surgery for my daughter. Does anyone else have any more imput? Regards, Debbie in IL In a message dated 6/16/00 5:51:44 PM Pacific Daylight Time, jhamilton@... writes: << After my insurance company asked for more testing I got the package together and within two days I had approval for surgery. Unfortunately, Dr. R is not a provider with Generations so they okayed the procedure with a doctor at UNC-Chapel Hill. He does a laparoscopic Roux-en-Y. The insurance company said to see this guy, talk with him, make a comparison, send then the information and they will make a determination on which is best medically for me. The lap Roux-en-Y will be a 4-6 hour procedure, 4-5 days in the hospital, so I hope just to save the money they will go with Dr. Rutledge. -- In Min >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 16, 2000 Report Share Posted June 16, 2000 Hi, This is just my opinion, and my daughter is not yet approved by Cigna, but I WOULD NOT let the insurance company determine which surgery is best for you. I would send them the info, showing strongly and definitively why the MGB is FAR superior. Don't let them be in control of your body. I would not even go see that Dr, as I DO NOT want that surgery for my daughter. Does anyone else have any more imput? Regards, Debbie in IL In a message dated 6/16/00 5:51:44 PM Pacific Daylight Time, jhamilton@... writes: << After my insurance company asked for more testing I got the package together and within two days I had approval for surgery. Unfortunately, Dr. R is not a provider with Generations so they okayed the procedure with a doctor at UNC-Chapel Hill. He does a laparoscopic Roux-en-Y. The insurance company said to see this guy, talk with him, make a comparison, send then the information and they will make a determination on which is best medically for me. The lap Roux-en-Y will be a 4-6 hour procedure, 4-5 days in the hospital, so I hope just to save the money they will go with Dr. Rutledge. -- In Min >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 16, 2000 Report Share Posted June 16, 2000 In a message dated 6/16/2000 10:39:01 PM Eastern Daylight Time, DebLaMan@... writes: << Hi, So you can't have thyroid problems?????? Regards, >> Mine barely exist and I had the surgery! Trisha Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 16, 2000 Report Share Posted June 16, 2000 >> Hi, So you can't have thyroid problems?????? Regards, Debbie in IL>> _________________________________________________ Debbie - I don't actually know why they asked for the thyroid test. I just assumed it was to rule out any thyroid problems before okaying WLS, but I never thought to ask. Sorry I can't be more helpful! M. MGB 6/7/00 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 17, 2000 Report Share Posted June 17, 2000 Hi , Thanks! Regards, Debbie in IL In a message dated 6/16/00 8:39:32 PM Pacific Daylight Time, JULIE0630@... writes: << << Hi, So you can't have thyroid problems??????<< I tested for hyperthroid (was slightly underactive) thru 2 blood tests and normal for the 3rd. So, no meds for me. But my surgeon and my PCP and another doc all said it wouldn't stop me from having surgery. Hope this helps. Hugs, Rose >> Quote Link to comment Share on other sites More sharing options...
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