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grievance after being denied from BCBS



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Has anyone after being denied had any success with a grievance against BCBS. I really want to do the surgery but they have denied me b'cause my blood pressure is under control with 2 meds.

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I have BCBS as well if your BMI has been over i think 45 and you have two comorbitities then you should be approved blood pressure controlled by meds or not... if your BMI has not been over the allowed amount for three years then it will be harder.... It is a lot of work to get qualified but it might help if you get a letter from a doctor either if you have back problems or heart conditions or someone saying arthritis in your knees... I have not been approved yet one more visit on the 30th for my six months but they basically said that i would be approved since my BMI has been greater then 50 for the past three years other conditions or not

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I have BC/BS and have just started the process. What is your BMI?? I have read the benefits packet in detail and it clearly states that if you are over 40 BMI, you qualify w/out having to have co-morbities....

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I also have BCBS and after being told that my doctor's office had not submitted all the required paperwork and then being told I was denied because of lack of info on comorbidities and then appealing and finally being approved..... it is all worth it in the end. Call your insurance company everyday and sometimes twice a day, make sure you write down names of who you talk to and get specifics on what they want. Through this whole process I learned that they don't really look at what is in front of them and different people will give you different answers. If you need any help or more info just message me...Best of Luck

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I also have BCBS and after being told that my doctor's office had not submitted all the required paperwork and then being told I was denied because of lack of info on comorbidities and then appealing and finally being approved..... it is all worth it in the end. Call your insurance company everyday and sometimes twice a day, make sure you write down names of who you talk to and get specifics on what they want. Through this whole process I learned that they don't really look at what is in front of them and different people will give you different answers. If you need any help or more info just message me...Best of Luck

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Hi all: thanks for your support with my appeal to BCBS. I took some time and put together an extensive appeal with letters from my Drs stating that I have HBP for 20 years which is not always under control, back pain, knee pain, etc. They finally approved me after a Level 2 appeal. I'm happy about this but now scared at the thought of getting banded.......am I insane. Its been 1 1/2 years since I began this process and really kind of thought it wasn't going to happen. Now I must get my head back in the game and get prepared to do this. I'm seeing the surgeon again on tuesday.....since I have not spoken to him in over a year. I have new questions now that this is a reality. thanks again for your support CAT Lady

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Bcbs was very easy for approval for me as long as i had a bmi over 40. Make sure your Dr puts all the paper work in and i wrote a detailed 5 page letter of all my attempts over the years with weight loss. I was approved in 3 days.

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So I had my lapband on 12/7/12 with Anthem BCBS. I had no trouble getting approved in 2 weeks. Then after one year of constant vomiting fills and unfills. I was only able to get 4 cc total into my 14cc band. I started to have Migraines, panic attacks an finally seizures. I was never diagnosed with epilepsy. I told my surgeon every month that I was having trouble an NO substantial weight loss Every time I went into office he paid no addy entomb to my concerns! Finally (at my 1 yr Mark )he completely removed all Fluid from my band and stated clearly the band was causing more harm than help and I was suffering from Band intolerance. He said he would do what ever it took to seek the sleeve for me as it was medically necessary to have the band removed immediately! I got a call from my health advocate stating I was denied a conversion. Although the Removal was Approved. I asks the advocate what was in the letter. She stated my surgeon mad no mention of my issues.. No mention of intolerance! No mention of my seizures or the fact that I was on 200 mg of antiConvulsion meds along with Prozac and Xanax. Basically I was denied since My surgeon didn't supply enough info. WTH!!! I was livid! So I got a new surgeon since my primary failed me he lied! He also said it was going to be difficult that I was the 1st to have this issue or the band removed from his office (another lie) My new surgeon confirmed by band could not be salvaged. Also through the barium swallow discovered the band was too high and even if repaired would slip right back up due to an indention That was already created. My new surgeon stated he had no respect for my previous surgeon or his techniques as a matter of fact he had already removed 25 lap bands from (MY surgeons office) in the past year alone! So my new surgeon is attempting to help me file a Grievance and hopefully bcbs will reconsider my conversion to the sleeve!

Edited by PhatKat1127

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Good luck on getting the denial reversed. I also have lap band failure. My port dislocated and my band slipped. Right now I can't eat anything nor can I get an unfill.

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I am so sorry for what you are going through! Out of the 7 yrs of research I had done on this, I never heard LAP BAND INTOLERANCE! I am left with 12 Scars no weight loss and even worse health conditions. But as I read about it I am seeing more and more people that are going through this.

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Tonight I can't sleep!! As I research all avenues I really hope my New surgeon who removed my band (due to intolerance) has supported enough in the greivance process gets a BIG PHAT YES!

I didn't do anything to deserve this! I followed the rules but apparently intolerance was my obstical... I pray to God I get approved for the conversion to the sleeve!

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
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    • KimBaxleyWilson

      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
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      https://alluniqueguide.com/java-burn-coffee-reviews/
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