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Omg! My External Appeal Was Approved!

  • Popular Post

I just got the mail & I seen a letter from the external appeals place & was instantly sick to my stomach. I was convinced this was my final denial for the sleeve. So I went ahead & opened it & it has been APPROVED!!!!!! OMG! I am beyond excited right now!! If anyone is going through this or wondering if it is even worth it, the answer is Yes! Fight for it! I'm so glad I did!! I was denied by Highmark because my bmi is not 50. But with much perserverance, research, proof, & appeal writing I GOT APPROVED!! WooHoo! Can you tell I'm excited?!? :)

  • Replies 21
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  • Wheetsin
    Wheetsin

    Congratulations! RE: saved money - I told DH that since the surgery would've cost about $13K, but I got my denial reversed, I sort of saved us $13K, so it was kind of mine to do as I wished with. I

  • tumblersmom
    tumblersmom

    I was denied bcuz my bmi was under 50. My advice is jump thru their hoops & fight for it!! I did an expedited internal appeal & then had to do an external appeal to an IRO (independent review

  • Gene1970
    Gene1970

    Congratulations!!!!!

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Yippie for you!!!

  • Author
Yippie for you!!!

Thank you!!

  • 2 months later...

Congrats to you!!!!..That is great news....I am actually a bariatric coordinator working with a patient TRYING to get the same thing accomplished. Our situation may be similiar to yours, unfortuantley we are requesting approval for a SLEEVE from HIGHMARK and due to BMI of 42 it was denied :(.......they require a BMI of 50 ...So since you were sucessful in your quest can you give me some hints that helped with HIGHMARK so that hopefully I can also get this approved for him...THANKS ..

Congrats! I had a small fight...I was approved thru BCBS after a peer to peer review.

Congratulations why were you denied in the first place? I'm going through this now. Any suggestions? ?

  • Author
Congratulations why were you denied in the first place? I'm going through this now. Any suggestions? ?

I was denied bcuz my bmi was under 50. My advice is jump thru their hoops & fight for it!! I did an expedited internal appeal & then had to do an external appeal to an IRO (independent review organization) before I was approved. If you have to do appeals put as many medical facts in it as possible & explain why the vsg is the best surgery for you without making the letter to personal.

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