Questionable VSG approval from AnthemBC

My apologies - I originally posted this under the General Forum, but was instructed it would be more helpful to post in the VSG forum, so sorry about the cross-posting...

Hi folks -

Really stressed out at the moment. I know I'll be able to call my surgeon and Anthem on Monday during business hours, but until then I'm feeling like I may not be getting what I've worked so hard and passionately on to achieve.

I've away from homebase, traveling for work -

On Wenedsday (22nd), surgeon calls me to inform me that I've been approved by AnthemBC for VSG. Absolutely elated. We set a surgery date for July 5th, and I send a cashier's check for the post-op program fee.

On Friday (25th) I called AnthemBC to ask about my copays and deductibles regarding my out-of-pocket costs, and they nicely answer all my payment and coverage questions, and act as if I am indeed certified for the surgery.

When I returned home Saturday, I had mail from AnthemBC dated Tuesday (21st), saying my outcome was "pended", and that I would have to instead provide MD notes and exam findings, disgnostic testing results, prevoiusly tried treatments and medications, and any other information that I feel would support this request.

I know when business opens up tomorrow on Monday, I'll be able to figure out what's going on, but until then I'm stewing. Did AnthemBC tell my surgeon the wrong thing? Did my surgeon tell me the wrong thing to get my payment? Is my surgery date going to have to be a month or two away instea of next week? (due to travel obligations, this is really the only time I can have the surgery until the winter holiday.)

I just got so, so, very happy and excited when the surgeon's office told me I was fully approved and we set a date. Now I feel a bit crushed. Hard to wait for tomorrow to get some resolutions

Has anyone else had a similar experience?

Perhaps the mail is lagging  behind, and your doc has the approval.  You know the company sent the letter to you and in the interum your doc cleared it up.  I don't know, but don't dispair; you may have a few more hoops to jump thur, or maybe not.  Sorry I can't help.  Hopefully you can clear it up tomorrow a.m.  Best wishes!

Sometimes one end of the insurance company doesn't know what the other end is doing. I had a devil of a time getting my paperwork marked as received by the company when in fact it had. There are ways to handle it if the insurance company is still hassling you. Let me know if I can help

Thanks Sandy, for the kind thoughts, and roundater, I may have to take you up on that offer.

Totally agree with Roundater! Don't sweat it till business opens.. and a small (funny) tip- never, ever open official mail especially from insurance companies on a weekend! It sets you up to be just fuming and worrying with no one to call until Monday morning! (Learned the hard way, now we just set it aside till the weekend is over..)

Well after the surgeon said we were go, and the insurance company said there would be nothing out of my pocket, I just expected that envelope to contain the 'yes' letter!  :(

Prepare for the worst - that way it wont be such a let down if they make you jump through hoops. Still jumping hoops myself. Good Luck

Good news everybody! (Professor Farnsworth)

Turns out I was worrying over nothing... it was an initial auto-triggered form letter.  I called the pre-cert division, they said it was still covered, and an updated letter would be mailed out today (a few days after they informed the surgeon!)

Thanks for the great advice guys ;)

One wee****il surgery!

 I was just about to post and tell you I have Anthem BC and it was no problem to get my surgery - but I see you already have the good news!  Congrats to another Nor Cal sleever-to-be, good luck to you!!

Thanks so much Kristy!