OlRachel

Charting. Typo

Pretty sure the appeal will be denied because it's based off a previous coverage requirement

I was denied due to poor chatting notes from pcp. Appeal sent friday

Regence bcbs of oregon has changed its policy to 3 months within 12 months from 6 months within 24 months. Perfect for some shitty for me. My info was submitted in November based on old criteria and just sent in the appeal and policy changed 12-1! I'm so mad. My diet was done 24 months ago is why I'm upset. But good change in general

Starting appeal process so it's looking more like January for me, unless I can squeeze in this month!

72 hours in unheard of. Mine took 13 days and they wanted more information, sent that in then 8 more days to say no. I sure hope its that soon for you though

2 hours ago, DanieHall said:

What is a peer to peer appointment? I haven’t been informed of this and am just curious. Hope you get in by the year end!

Mine is a peer to peer apt on weds

3 hours ago, gym&tonic said:

Thank you so much for the info! Im on the phone with them right now checking in

What'd you hear?

5 hours ago, gym&tonic said:

My surgeons office supposedly sent all the required paperwork to Blue Sheild on 11-16 but If i get denied then it will be a tight squeeze to get an appeal and scheduled for surgery before the end of the year. Which for me is critical because I turn 26 on Dec 26 and then will have a new insurance and would have to start the process all over

My suggestion is to keep calling insruance everyday. Dont wait for your office to get the call or the letter. I still havent gotten my denial letter in the mail but I called everyday so I knee right away and we have already scheduled peer to peer

3 hours ago, ekstone86 said:

Me! They sent the approval letter off this week and I'm hoping to hear back in the next few weeks. My PCP and surgeon are all trying to get me in this year. *fingers crossed* for all of us!

You have an approval? Have them send it to you electronically or to your insurance portal and then send it to your surgeons office. They are so slow, do the leg work for them

23 hours ago, Wickedwinner said:

Just got scheduled for pre-op surgeon appointment on Dec 11 after which they will set my date. Should be before Dec 31. I think I’m going to go ahead a start the pre-op diet in the hopes of getting in sooner. If they have any cancellations I’ll be ready to go.


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That's a good idea! I'm on my drs preop diet because his is just a low carb diet under 40 grams a day, I always est under 25 a day anyway so no big deal here. My peer to peer k scheduled 11/21

Excited, have you called your insurance company directly to ask? How long has it been?

Waiting on surgeon to schedule the peer to peer. I'm hopeful cause I have to be. If they dont accept that diet as a 6 month diet because of the chart notes then it looks like February for me. And a new deductible and all that crap

My insurance is trying to do a peer to peer review because the documentation from my pcp isnt clear about the 6 month diet

How did you get a surgery date without preauthorization? I wish I could!

Oh I hope you do!!!

I'm starting the appeal process myself, but I'm praying to have this surgery before the end of the year!

Anyone else not approved yet but hoping for this year? What stage are you at?

Damn. I'm so upset. I legit think it's because when they requested more info it said, that the patient is not being treated for GERD and my dr didnt address that and the insurance coordinator didnt catch it and sent it in. praying that's all it is and that we can just point it out in the provided chart notes that it's not indicated I am and dont need to appeal.

I cannot get this surgery next year, this is my only chance!

I was denied 11/8 for the gastric sleeve and dont know why yet as I had called and got my answer. So I'm waiting on the letter they send out to tell me exactly why. How long did it take if you got one? 7-10 days is the normal they said but I'm praying itll be less! Or did your surgeons office get the letter emailed first?

Is there any hope to getting this surgery before the end of the year? I can't do it next year

I have to have surgery before end of the year! 7-10 days for letter listing reasons, appeal takes up to 15 days. Then for insurance at surgeons office to hurry and file ththe appeal.

2 hours ago, johnsons13 said:

My first doctor documented exactly that but refused to submit it saying that she wasn't my weight loss dr but my primary. My weight loss dr and myself argued saying that was the point. But whatever.

My 2nd doctor documented the same thing, but this time my surgeons office had a piece of paper they made 6 copies of that listed my co-morbidities, my current weight, previous weight, blood pressure, and glucose. That was all they submitted to my insurance and they approved it with that.

I am going to print off some forms today and bring them to my pcp then. I had to kinda make them but it should be fine. My surgery office doesnt have them. Go figure.

Comeauxrachel@ymail.com

Thanks!

It appears my dr didnt send in any chart notes worthy of the last month we've spent waiting on an answer. She didnt put any of my weights in her notes and basically just wrote that we talked about diet and exercise! So, please help me figure out exactly what she needs to have in the chart notes for it to be clear to insurance. What'd your dr write or did they use a form to document it? Please help! I'm onto my appeal now since it was denied

It sucks because I know it's because my drs chart notes are literally terrible. She just scribbles them on lose papers. So I know it's her lack of information in her notes about the diet is the reasons

None of them are. This is so odd!!!