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GHI & BCBS

camille01

By camille01, in Insurance & Financing

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krenee    8

krenee
Posted

They did the same thing for me. My PCP wrote a letter and when they denied the inital claim, they said I did not have a medical necessity letter. So my PCP wrote a more detailed letter. Now I had to do blood work over and EKG. I hope I hear something positive as well. I called Lennox hill Friday morning but could not reach the surgical coordinator. which has also been very frustrating, because you always have to leave messages.. I dont want to seem like a bug-a-boo, but I am anxious!

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Hibmirn    0

Hibmirn
Posted

Me too! I think they are a great surgical team and I think Roslin knows how to fight for his patients. The latest for me to hear back is April 5th. I hope they don't take all that time to make up their mind. I am so anxious too. GHI is criminal in the way they treat their consumers. I will switch in November if they continue to treat me unfairly.

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Hibmirn    0

Hibmirn
Posted

Just got word today that my external appeal overturned GHI's decision to deny. I'm anxious and nervous at th same time. I'm scheduled for surgery on May 10th at Northern Westchester Hospital. I can't believe I got approved.

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krenee    8

krenee
Posted

Great to hear. My peer to peer was denied. And now they are doing the external appeal. I hope I get the same results.......Please keep me informed of your progress. When did you complete your 6 month diet?

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Hibmirn    0

Hibmirn
Posted

Have patience. You will get it. I am a nervous wreck thinking about the surgery but know I need it. I finished the diet in February. Roslin and his team are great at dealing with the insurance companies.

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krenee    8

krenee
Posted

Did you loose any weight on the 6 month diet and was it a formal diet, or were you just working out and watching what you eat.

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Hibmirn    0

Hibmirn
Posted

Did you loose any weight on the 6 month diet and was it a formal diet, or were you just working out and watching what you eat.

I gained weight! I did mostly weight watchers and tried Atkins and cheated like crazy! I was initially going to the gym but hurt my hip and stopped.

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krenee    8

krenee
Posted

I am sorry, I am asking so many questions.... But did you have to submit your weigh ins from weigt watchers or did your Dr. just write a letter documenting your weight loss efforts fro the last 6 months.

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Hibmirn    0

Hibmirn
Posted

I printed out some weigh in forms that I found on their website (Lenox Hill one) filled them out and my doctor signed them. I did not send stuff from weight watchers.

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krenee    8

krenee
Posted

spoke with surgical coordinator today and she said they sent my case for the higher appeal. i am getting frustrated at this point. If they deny it at that level, then I might just give up. Are you preparing for your surgery??

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Hibmirn    0

Hibmirn
Posted

spoke with surgical coordinator today and she said they sent my case for the higher appeal. i am getting frustrated at this point. If they deny it at that level, then I might just give up. Are you preparing for your surgery??

My surgery is scheduled for May 10th. I have not scheduled my GI series yet. The pre op testing - ekg, chest xray and labs need to be done less than 30 days before surgery. I am going to start cutting down the caffeine. I drink a lot of coffee. I will make my appointments this week. Right after Easter I will try to start a low carb diet in preparation. Please do not get frustrated or give up. It will happen for you. They are very good at what they do. After all the press yesterday about wls and diabetes, I'm sure it will happen. I will say a prayer and keep my fingers crossed for you.

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Sleevie WonderLand    41

Sleevie WonderLand
Posted

Krenee,

don't give up. even if you have to do the 6 month pre diet, do it. This surgery is worth it. If you really want to change your life and improve your health and need a tool that will prevent you from overfeeding yourself, then you need to be sleeved. Hang in there, and know that you have an entire community (VST) rooting you on. If you have to do the six month pre diet, then you can use that time to begin changing your eating habits and get a jump start on your exercise regimen. don't get discouraged....get sleeved!

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krenee    8

krenee
Posted

Finally!!!!!!!!!!!!!!!!! APPROVED!!!!!!!!!!!!!!! surgery May 29th!!!!!!!!!!!!!!!!!!! woohoo

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Trcyprkr70    69

Trcyprkr70
Posted

Congrats krenee, I know its been frustrating for you. Best wishes as you become a new and improve you.

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Go To Topic Listing Insurance & Financing

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