biancafg31

Well guys, I am afraid I have no good news. Anthem BC/BS denied my appeal level 1 as “investigational”. Surprise, surprise, right? Even after I have all my papers, letters from my doctors that stated that I need to take NSAID and my surgeon office provide medical researches on my behalf, no dice. Now I am fighting with them to let me bypass Appeal level 2 and go direct to Independent external review appeal witch I believe would be my best bet. I feel that Appeal level 2 will provide the same results since Anthem is not looking at your medical problems they are just hiding behind the policy. As I read this panel have three doctors independent of insurance panel that they look @ the medical necessity only. If they rule in your favor, the insurance has to cover your surgery, no questions ask. The whole thing It’s depressing and frustrating especially when all other major insurance companies already updated their policy to include sleeve. But I am still not giving up.

if you have BCBS you are lucky since they updated their policy on July 1st, so no more explination needs. I have Anthem BCBS and Anthem didn't update their policy yet so I need to appeal. The lady in the doctor office that makes the appeal for me said that they had win appeals from Anthem in the past. Hope it will work for me as well. Can't get too confident tho.

Jeannie, You r right, this is the policy, they didn't update it since January. I am going to appeal today. Did you got approved for VGS?

Donna, thanks i found it. u just had the surgery a week ago? How r u feeling?

i got it, u r right, i didn't scroll down to accept the rights, this is why i couldn't search. Thanks for the quick reply.

Do you have by any chance a link to their actually converge? I see they have a flash on the decision making but I would like a text since I have Anthem BCBS and they denial and I am appealing. I will like to attach they policy to my appeal letter. Thanks,