trilla

Congratulations on your surgery. The peer to peer call is tomorrow afternoon. I wrote a letter outlining my experiences before and after surgery and sent it to my doctor to have for supporting information during the call. I just hope I'm approved. I feel so powerless.

It is specifically related to the duodenal switch procedure. Congratulations on getting it done.

I have BCBS IL and I'm trying to get approval for a revision from RNY to Duodenal Switch. I am 290lbs with a BMI of 46.8. On 08/24/2018 my paperwork was submitted. I called my insurance company on 09/10/2018 and I was denied since BCBS IL coverage states that the Duodenal Switch is "not medically necessary for people with a BMI under 50.0". I was told it was in a "pre-determination" status and my surgeon can call for a "peer to peer" with a BCBS IL doctor in which my doctor could argue that it is medically necessary. Has anyone with BCBS IL been in my situation? Has anyone with BCBS IL gotten a Duodenal Switch and was under 50.0 BMI? Even better has anyone with a failed RNY gotten a revision to a Duodenal Switch and was under 50.0 BMI? I'm frustrated since I have been working to lose weight and I have lost just enough to be denied. If I were 20lbs heavier I would be approved. Our insurance is so messed up.... I called my doctor and they have an appointment with BCBS IL for the peer to peer on 09/21/2018. I just don't know what my odds are with getting approved. This is so nerve racking. Thanks in advance.