1St Appeal Denied

[tumblersmom 60]

Well the peer2peer didn't work & now they have denied my 1st appeal. I now have to write another appeal & send it to an external review company. This is crazy! I am getting so discouraged & feeling hopeless. But this is the surgery I feel is best for me so I guess I will keep fighting. Idk what else to do.

[LovetheBeach 3]

I hope you don't mind me asking what insurance do you have? I'm so afraid of this. I wish you the best and I will be praying for you for the next appeal!

[tumblersmom 60]

I hope you don't mind me asking what insurance do you have? I'm so afraid of this. I wish you the best and I will be praying for you for the next appeal!

I don't mind at all. I have Highmark Bcbs. Thank you I'll take all the prayers I can get!!

[Meljp 36]

Hang in there and keep on fighting. Don't take no for an answer. I know easier said than done, but you are "fighting for your life"...I am keeping you in my thoughts and prayers!!! Blessings~Melanie:)

[lisahg 9]

It is crazy but dont give up! I had to jump through the same hoops from peer to peer - external appeal too with my insurance Highmark BCBS. The Independent Review Organization (IRO) who reviewed my external appeal overturned Highmark's denials and I was approved. You typically get 15 days to submit your external appeal so take your time and write a solid letter and really sell your case. Quote and cite relevant medical journal articles on morbid obesity that support your arguments. http://asmbs.org/ is a great resource. Having the option to appeal to an inpartial (external committee) is a great opportunity because your insurance had no reason/benefit to reverse their decision regardless of what your 1st appeal letter contained. Good Luck!!

[tumblersmom 60]

Hang in there and keep on fighting. Don't take no for an answer. I know easier said than done' date=' but you are "fighting for your life"...I am keeping you in my thoughts and prayers!!! Blessings~Melanie:)[/quote']

Thank you I appreciate it so much!!

[tumblersmom 60]

It is crazy but dont give up! I had to jump through the same hoops from peer to peer - external appeal too with my insurance Highmark BCBS. The Independent Review Organization (IRO) who reviewed my external appeal overturned Highmark's denials and I was approved. You typically get 15 days to submit your external appeal so take your time and write a solid letter and really sell your case. Quote and cite relevant medical journal articles on morbid obesity that support your arguments. http://asmbs.org/ is a great resource. Having the option to appeal to an inpartial (external committee) is a great opportunity because your insurance had no reason/benefit to reverse their decision regardless of what your 1st appeal letter contained. Good Luck!!

Thank you!! I too have Highmark Bcbs. I had actually read your post a while back & that's what gave me some hope that maybe I too can win my case.

[tumblersmom 60]

@lisahg...when you filed your external appeal how long did it take to get an answer? Just curious.

[lisahg 9]

It was probably 3 to 4 weeks from the time I got confirmation that the Idependent Review Organization had all the paperwork from me and Highmark.

[tumblersmom 60]

It was probably 3 to 4 weeks from the time I got confirmation that the Idependent Review Organization had all the paperwork from me and Highmark.

Thank you!!

[circa 333]

don't give up! paying out of pocket should be a last resort! You pay your insurance premiums, get the most out of them that you can.

[tumblersmom 60]

don't give up! paying out of pocket should be a last resort! You pay your insurance premiums' date=' get the most out of them that you can.[/quote']

Thank you!! Self pay is not even an option at this point in my life.

[pussnboots 5]

KEEP FIGHTING!!!!!

[tumblersmom 60]

KEEP FIGHTING!!!!!

I'm sure trying too!! Thank you!!