Ugh! Insurance!!

[KristiinSD]

I just opened a letter from my managed care review that said they would need up to an additional 45 days to review my request for surgery. I don't think I can handle another delay in my surgery. I called all parties towards the later part of last week to make sure all was well...but I now understand why the insurance people were vague about this letter, they told me it was coming but nothing more concrete.

I guess I am going to be forced to leave my health group...or something. I can't really delay this anymore. I don't feel great and today I had pedal edema.

yuk

Kristi
mr

 

[Ross]

Tell them that is unacceptable and request an expedited appeal.

 

[BillCobit]

Tell them that is unacceptable and request an expedited appeal.

http://www.calpatientguide.org/viii.html

HOW LONG DOES MY HEALTH PLAN HAVE TO MAKE A DECISION ON MY INITIAL CLAIM FOR BENEFITS?


Under new federal rules that will apply to claims filed on or after January 1, 2002, the 90-day deadline will be replaced by a new set of standards:

Claims for urgently needed care must be ruled on "as soon as possible," and in no event more than 72 hours after the claim is filed.
Claims for pre-approval of benefits must be decided upon within 15 days.

Claims for reimbursement when you have already received care must be ruled on within 30 days.

 

[rbl1999]

Hi, I retired from Blue Cross Blue Shield and dealt with managed care issues. My advice would be to call and insist on speaking to the medical director... Also, your cardiologist and surgeon should be helping you to deal with this situation. They should have already been dealing with the medical director, that is part of their responsibility as participating physicians... Good Luck. Rose Also, your Primary Care pHyysician should be VERY involved...

 

[MelissaM]

I second everyone above. Call for an expedited appeal. Call the medical director. Switching will most likely do nothing for you except move your problems to another agency. PERSISTANCE is the key to dealing with insurance companies. . .even during the time you feel the least like being persistent.

Hang in there.

 

[ALCapshaw2]

CHANGING insurance plans mid-stream is NOT a good idea. You could end up with NO COVERAGE.

Bottom Line: Stay with the plan you have and follow the good advice given by the previous responders.

If you are having a problem getting to the appropriate people in your insurance company, TELL your Doctors to intervene on your behalf. They will know how to get the ball rolling.

'AL Capshaw'

 

[KristiinSD]

Thanks all!

Thanks all!

I really appreciate all the advice, esp. the California Patient website info. Seems like some phone calls on Monday will help this process along...My first surgeon was covered, and while he was fine guy now that I've decided on someone else, I don't think I want to go back to him....Hopefully, I will be able to keep the September 29th date. I feel like it is slow torture for my 7 year old to have the dates change...to say nothing of the guilt I feel about work. I am a professor and the administration relieved me of my course this semester so I could have surgery. I am still working with my graduate students and attending meetings and such, but I feel like I should be teaching.

 

[tobagotwo]

Go after 'em. No mercy...

Best wishes,