Question:
How long is too long to wait for approval?

We'll say that I began this process six months ago. It was circumvented by an individual at the medical group who was skeptical of me newly moving to the area, therefore my first group of referrals expired and were canceled. This second set has been in the works since 9/7/01. I have been waiting for approval on the surgeon consult for almost two weeks. The usual approval is 2-3 days. My PCP, and other individuals that work for the medical group have been making comments like it is bankruptcy for the medical group to perform WLS on an HMO patient, stating the likelihood of getting an approval are nil. Is this legal? Can they make these statments? Should I be paranoid, I think the medical director is sitting on the referral. I plan to write a letter to him directly if I don't have an answer by this Tuesday, or should I be more aggressive?    — [Anonymous] (posted on October 8, 2001)

October 7, 2001
The way I feel is the squeaky wheel gets the oil. When I was waiting for approval, I called every week (at least) and then eventually everyday when I kept getting people that didn't know the answer to my questions. I made several phone calls in one day trying to track down the correct person to speak to. I would call the insurance company and make sure they have received the request for approval and see if it's being reviewed. They're not going to deny you because you're annoying, you just might get an answer sooner so they can stop hearing from you. Good Luck.
   — [Anonymous]

October 16, 2001
I sympathize with you. My struggle hasn't been as long as yours. In fact getting my PCP to give me a referral was the easy part. I have had my surgical consult, my paperwork has been submitted and now I feel like a ping pong ball between my surgeon's office and my insurer. I don't know when I am getting a correct answer. I'm just keeping on it, calling them every few days. Good luck! Could you change PCP's? Perhaps find one who is more reasonable.
   — V R.

October 16, 2001
I sympathize with you. My struggle hasn't been as long as yours. In fact getting my PCP to give me a referral was the easy part. I have had my surgical consult, my paperwork has been submitted and now I feel like a ping pong ball between my surgeon's office and my insurer. I don't know when I am getting a correct answer. I'm just keeping on it, calling them every few days. Good luck! Could you change PCP's? Perhaps find one who is more reasonable.
   — V R.

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