DENIED Blue Cross and I'm RANGING with anger!

[blondebomb 580]

@@roundisashape I was another one that started getting bills from the hospital a few months later an boy I got on the Ins immediatly. I had about 4 differant bills or statements an I called the Ins an then she called the hospital all 3 of us were on conferance call straightening this mess out. it took almost 4 months to get all settled between hospital an Ins...but they did. I also have BCBS most generally I dont have a problem but I had a feeling this one would be screwed up! sure enuff!

[beachhippie217 7]

A lot of insurance companies are not going to pay for another WLS if you already had one. If you think about it, if you didn't have success with the band why would they want to foot the bill for another surgery and you not be successful with that. And if you can't follow the rules for the band you aren't going to be able to do it for the sleeve or bypass surgery. Unless you are having a serious medical problems with your band they will probably not approve you. There has also been a huge increase in these requests with the popularity of gastric sleeve surgery. Everyone wants to switch from the band to the sleeve and the insurance companies are getting really strict and examining every case.

I have a friend with the band and she called to see if she would be eligible to get the sleeve. They told her that unless your life is threatened and you are having life threatening medical problems and they need to take the band out you won't get another WLS. I'm sure in certain situations they will clear some people.

As far as Mexico- there is no way in hell I would ever go there for surgery or anything else medically related. People die there all the time from surgeries!! That is where all the hacks and want- to- be- doctors go to make money. You realize a plastic surgeon can go to a "seminar" and get licensed to do sleeve surgery. If your surgeon isn't BOARD CERTIFIED do not let them cut you. You are basically paying for a butcher. I wouldn't risk my life. I would try to make the lap band I already have work for me. Than to go to another country where you risk infection and questionable doctors at best. Just because it is cheaper, easier and there is no paper work doesn't mean that it's better or safe. I feel sorry for the people that are so desperate or have crap insurance that they have to go to Mexico for surgery because they feel like they have no other options. I think that is just asking for trouble.

[IcanMakeit 1,319]

@@beachhippie217, I think your assumptions about surgery in Mexico are unfair. While I'm sure there are some unqualified surgeons and some surgical centers which do not provide proper care in Mexico, that is also true for the U.S. Many people on this site have found skilled and caring surgeons in Mexico. You have to do your due diligence no matter where you are having surgery.

[JamieLogical 8,727]

As far as Mexico- there is no way in hell I would ever go there for surgery or anything else medically related. People die there all the time from surgeries!! That is where all the hacks and want- to- be- doctors go to make money. You realize a plastic surgeon can go to a "seminar" and get licensed to do sleeve surgery. If your surgeon isn't BOARD CERTIFIED do not let them cut you. You are basically paying for a butcher. I wouldn't risk my life. I would try to make the lap band I already have work for me. Than to go to another country where you risk infection and questionable doctors at best. Just because it is cheaper, easier and there is no paper work doesn't mean that it's better or safe. I feel sorry for the people that are so desperate or have crap insurance that they have to go to Mexico for surgery because they feel like they have no other options. I think that is just asking for trouble.

Holy ignorant, Batman! Do a little research before you spout this crap. There are world renowned surgeons in Mexico. My surgeon was one of Newsweek's Top 15 Bariatric Surgeons and is a Fellow in the American College of Surgeons (FACS). Are there shady and terrible doctors in Mexico? Sure! Just like in the US! But to make a blanket statement against all Mexican surgeons is just plain ignorance. As for people "dying there all the time" from surgeries... I would guess that the mortality rate of top tier Mexican surgeons is lower than many/most US surgeons.

[Mom0f3inOC 11]

UPDATE

After peer-to-peer I was APPROVED!

My doctor said it only took 5 minutes to get it approved. Apparently the doctor she spoke to said it would apper that the person who originally denied the claim didn't even read the file because this one is a "no-brainer." I agree and that's why I was so shocked!

Thanks for all of your encouragement!

I will add that after about 2 days of being shocked and really mad, I settled down and was ready to go hard in the appeal process. Yet, I was actually so at-peace with everything that I was even okay with not having the surgery, if that's the way the appeals went, becuase I know that in the end, whatever happenes is the right thing.

[BLERDgirl 6,417]

@@Mom0f3inOC - YAY! so happy for you. This is why I always advise people to appeal.

[borg/assimilated 576]

Way to persevere! I am happy for you.

[JamieLogical 8,727]

So happy for you and glad you didn't give up!

[blondebomb 580]

Yaaaaaaaaay!!!!!!!! congrats!!!!!! I was hoping it would work out!!!!! Date yet?

[ccol625 14]

Congrats to you!!!

I am going through the appeals process right now. I got the call from my insurance company (BC/BS) yesterday that the request was denied and I almost had a breakdown. I called the doctors office and insurance company today. The doctors office gave the incorrect BMI so hopefully that will help my case. Of course my BMI is 38.73 so still in the gray zone. I was 39.67 last month and I was told I needed to lose weight for my insurance company to possibly approve me. I don't have any major co-morbidities, however have hypothyroidism, high cholesterol, severe GERD with Barrett's syndrome (precursor to cancer), and stress urinary incontinence. I have had a BMI in the last 5 years as high as 42 so I am right there. I may have to gain 6-7lbs to be over the 40 BMI to guarantee approval. It just sucks that I have to gain a couple of pounds to qualify.

Hoping the appeals process will work in my favor since I am already on the OR schedule for 3/31.

Congratulations again and wish me luck too!!!

[dadempsey 5]

@ccol625- I completely HATE that you have to maintain a heavier weight just got be authorized for this surgery. To me, this surgery represents a last ditch attempt to get my weight under control after trying and failing at so many diets. The money insurance company save by people who have the surgery far outweighs this initial cost. so frustrating