Federal BCBS has apparently denied me for VSG

[Anumarie 17]

The surgical coordinator at the WLS center told me last week Friday that she received a message from BCBS. She said once we get the denial notice we'll forge ahead with an appeal. But I'm totally disappointed and confused. And I've received no notice of denial to date. I've done everything per the guidelines for approval that Fed BCBS outlines. The surgical coordinator said the BCBS rep mentioned it had something to do with my 3 mos requirement in a medically supervised program but I turned in all the paperwork that shows I did one for four months within the last two years (which is what Fed BCBS says is a prerequisite). Has anyone else had this issue and how was a it resolved?

[Miss Mac 6,261]

BCBS Federal can assign a case manager / advocate to you. You need one in your corner to help you bob and weave through this process. This is the hardest part right now.......waiting and waiting and waiting for approval. Chin up, kiddo. My case manager is at the Richardson Texas office for BCBS.

[Elode 8,093]

C@@Anumarie you can call and talk to a BCBS rep and find out what's going on. I have BCBS Fed and I called plenty of times for different things. It could just be paper work mistakes? I would call and see what you can find out.

[Anumarie 17]

Thank you all so much. Will call first thing in the morning!

[Rovobay 920]

good luck. I wish they get you straightened out ASAP. I have them, and are easy to work with, I am hopeful it was just a clerical error.

[Elode 8,093]

Give us a update when you find out anything.

[Anumarie 17]

As of right now BCBS said the denial notice was sent to me and my surgeon's office on 3/20 but neither of us has received it. I'll keep you all posted as the situation progresses.

Edited March 28, 2015 by Anumarie

[jane13 2,256]

please update as soon as possible because I am also waiting for a response back from BCBS fed emp and I was told that as of 2015 a lot of the requirements had changed since I originally started this journey in Nov of last year. I feel frustrated for you.

[typhanee007 1]

Anumarie I so feel your frustration. I too just got denied through Federal BCBS on March 11th.

I've helped the Care Coordinator @ the hospital compile chart notes, & other info. My surgeon was going to do a 'Peer to Peer' but I was notified earlier this week that Oregon BCBS doesn't do Peer to Peer. It's so dang frustrating & I HATE playing the waiting game.

My best advice to you (and me) is stay positive & proactive.... And appeal that Shiz!!!

[Anumarie 17]

Hello all!!!!! So I just found out my appeal worked and I'm approved for surgery!!! Looks like it will be in August! I'm excited and nervous at the same time. New and healthier me here I come! ☺️

[TX302 3]

Good to hear, I'll be dealing with them soon (they'll be dealing with me ) hopefully I can avoid the theatrics and they'll play straight with me.
Are you on the standard or basic?

Edited July 16, 2015 by TX302

[Anumarie 17]

Fed BCBS basic. ????

[1SlimmerMe 122]

@@Anumarie congrats! You've made it through the biggest challenge, it only gets better from here!

Edited July 17, 2015 by 1SlimmerMe

[Anumarie 17]

Thank you @@1SlimmerMe

[trekker954 421]

I also have BCBS FEP, but just beginning stage to finding a doctor, let alone deal with BS yet. I do have a question though I hope some can clear up, especially being other FEP members.

At what point do you apply for insurance. I keep reading all the hoops one must jump through. I have had supervised WL programs documented (I hope BCBS would waive that requirement to be on a WL program for (is it 3 or 4 months) and the psych evals and nutritionist. So those are what I have read here.

Say during my first doctor consultation and like that doctor and he weighs me and I meet the BMI 40. The doctor (assuming it is BCBS doctor and Center of Excellent hospital) that I am looking at. So is that when he would submit the required insurance; and is that when I assume they will come back and say I need to do the WL program, psych, nutrist and then will be approved? If I go on a WL program for 3 months, I would not doubt drop under the BMI 40. Is that when they deny things? Or if you check every box, regardless if I dropped to 38 or 39 BMI would they acknowledge my dedication.

I'm just don't understand are you approved but then have to meet all those requirements, or is the weight in prior to asking about insurance coverage. Also, if insurance gives you the requirements you must meet first, are you chosing your own pyschs, nutritionist, wl programs, or are these professionals, based on the bariatric surgeon recommendations.

I hope I'm explaining my confusion.