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Denied Blue Shield Of California (Ppo)
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Appeal! There is an appeal sample letter here: http://www.formerlyfluffy.com/bariatric-surgery-insurance-appeal/ Also you might give them a call at OAC and see what they suggest: (813) 872-7835
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Documentation is the key. If the documentation was not submitted by your coordinator prior to submittal this is her fault, not yours. I would think you have more than enough history to warrant the s
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sleep apnea, high blood pressure and pre-diabetic after having gestational diabetes is three comorbidities. The GERD isn't considered a comorbidity and actually after the sleeve it could exacerbate i
I have received my letter of denial today. It states the a Medical director has reviewed my request and has denied it because "The documentation does not demonstrate significant obesity-related complications (comorbidities) which have failed to be controlled with medical management."
I am really disappointed. My coordinator swore i would be approved because I had gestational diabetes, i have one kidney due to donating it to my father who has diabetes, kidney failure, rhinoplasty (spelled wrong but he can go blind from diabetes), high blood pressure, quadruple bypass, and some, and I was diagnosed with sleep apnea. I am so scared because all diets have failed even though i try so hard. I have three beautiful little girls, ages 14, 11, and 1 and i fear that i am following my dads footsteps.
I talked to the coordinator and she states i should have been approved. She states although the sleep study was included in the paperwork that my doctor did not note it in his letter. He did not state that i had Sleep Apnea and now use the CPAP machine. I hope this is why i didn't get approved. My coordinator is going to try and set up a peer to peer review. If this does not work she is going to try an appeal.
I have made a doctor's appointment this Tuesday with primary because i believe that I also have GERD (have all the symptoms).. Do you know if GERD can help me get approved if i do have it? What if I ask my primary to write me a letter of recommendation? or ask my last doctor who I went to for ten years to write me a letter of my struggles of weight?
I am looking at Obesity all my life (bmi just under 40), gestational diabetes, mild case of sleep apnea, possibly GERD, one kidney, and family history of diabetes, arthritis, high blood pressure, kidney failure.
thanks fpr your help and support,
Denise