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Being denied......

LivingForGod

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LivingForGod    111

LivingForGod
Posted

Hello all. Im just wondering was anyone denied and did an appeal and approved??? What were you denied for?? How did you win your appeal?? Who was your insurance company?? PLEASE COMMENT!!!!!!

GOD BLESS!!

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cbwalker79    187

cbwalker79
Posted

Hey Living for God. I was denied with BCBS Fed because the provider exhausted all of appeals. I had unlimited appeals so I wrote a letter to my insurance company with all of the information and I was approved within a week. Don't ever give up because you have rights! Keep fighting and hang in there. Today is my surgery date

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LivingForGod    111

LivingForGod
Posted

Hey Living for God. I was denied with BCBS Fed because the provider exhausted all of appeals. I had unlimited appeals so I wrote a letter to my insurance company with all of the information and I was approved within a week. Don't ever give up because you have rights! Keep fighting and hang in there. Today is my surgery date

Thank you! Im not giving up. Im sending all my paperwork in today for my appeal. I hope everything goes good with your surgery! Keep me posted!!!

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1Day1Life4Now    882

1Day1Life4Now
Posted

Hey Living for God. I was denied with BCBS Fed because the provider exhausted all of appeals. I had unlimited appeals so I wrote a letter to my insurance company with all of the information and I was approved within a week. Don't ever give up because you have rights! Keep fighting and hang in there. Today is my surgery date

Hi CB I also have fed BCBS. I'm still waiting on approval. Did they give you any reasons for the initial denials? What was the difference in what you submitted for your appeal and what the doctor submitted? I am concerned that they won't approve mine and I've been waiting for the last 3 months.

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cbwalker79    187

cbwalker79
Posted

First appeal was denied due to missing information (proof of failed diets and nutritional evaluation was negative) 2nd appeal customer service representative said they didn't receive psychological info . Waisted an appeal re sending that document. Then my provider scheduled peer to peer review with medical director and they explained that I was missing the information and to resubmit. However when provider resubmitted BCBS Fed said all appeals had been exhausted and BCBS Fed and they never looked at new information. I wrote the appeal letter and was approved within a week

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Beach Lover    1,084

Beach Lover
Posted

Good for you!!! You are going to really love your sleeve and new life! :)

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LivingForGod    111

LivingForGod
Posted

Good for you!!! You are going to really love your sleeve and new life! :)

Thank you so much!! Im soo happy right now!

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cbwalker79    187

cbwalker79
Posted

congratulations i know you gotta be on cloud 9

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LivingForGod    111

LivingForGod
Posted

congratulations i know you gotta be on cloud 9

YES I AM. I'VE CALMED DOWN A LITTLE. BUT WHEN THE LADY FROM MY INSURANCE EMAILED ME THE LETTER I WAS LIKE...REALLY????

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
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    • Aunty Mamo

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      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
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    • BeanitoDiego

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      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
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      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
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    • BeanitoDiego

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      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
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    • ChunkCat

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      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
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