DENIED Blue Cross and I'm RANGING with anger!

[Mom0f3inOC 11]

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Edited March 5, 2015 by Mom0f3inOC

[BLERDgirl 6,417]

Oh my gosh I am shocked and absolutely RAGING angry!

I have 35 bmi and 1 co-morbidity, Upper GI documenting problem with band. I fit exactly what BC says I have to fit.

Nevertheless DENIED!

They say too experimental. WHAT THE???? The policy says they do revisions if you meet the qualifications and I DO fit the qualifications. WHAT THE @$#%$^%^&

I feel totally hopeless and beyond angry. What did my doctor say in that submission to screw it up? What did he do and why? I should have been a slam dunk! I am seeing RED!!!

Appeal.

[JamieLogical 8,684]

You should definitely go ahead with the appeal. Right now you feel like all hope is lost, but you still have a chance with the appeal. You have NO CHANCE without it.

[LipstickLady 25,682]

It's unfair to blame your doctor before you know the details.

[BLERDgirl 6,417]

You can give up or you can appeal. Insurance companies can be particular and arbitrary. What may often look like a slam dunk can and has been denied.If you want this, fight for this. Do the appeals and work the process.

or sit home mad.... Your choice.

[Mom0f3inOC 11]

Just curious, have any of you been denied and successfully appealed?

Edited March 5, 2015 by Mom0f3inOC

[Mom0f3inOC 11]

.

Edited March 5, 2015 by Mom0f3inOC

[Cody's mom 247]

And if worse come worse, save up and go to Mexico, cheap, safe, and no hoops to jump threw. Best of luck!

[JamieLogical 8,684]

And if worse come worse, save up and go to Mexico, cheap, safe, and no hoops to jump threw. Best of luck!

That's what I did. I didn't stand a chance with my insurance company because they required a five year documented weight history of a BMI over 40 or 35 w/comorbidities. Shame on me for at least TRYING to do it "on my own" and having lost 90+ pounds back in 2010/2011. That put my BMI well below 40 until it slowly crept back over 40 this past summer. So my options were self-pay or stay fat for another 3-4 years to meet their stupid requirements!

[bvenegas 89]

I feel ya! You should be super mad, I would too and it's only normal. After a day or two when you see a lighter shade of red, becuase you will prob still be upset just think about it a little more, but dont give up. Keep it moving, I'm sure it will work itself out. I had a situation about two weeks ago where I finished all the req. and had the paparwork submitted to have it kicked back due to BC having new 2015 requirements (requirements changed from 3 month weight monitoring to 6 month weight monitoring). I was origionally told that the new rules would go into effect until March, so I felt hopeless as well when I found out. I felt my body in a rage and I was in tears becuase it's one thing when you dissapoint yourself, but when someone else dissapoints you after you have done your part, that was the worst for me. So i hear ya but take a day or two then think about it, then do what's best for you.

[Stevehud 1,790]

i was denied twice and made it on the third appeal. im two months post op now, so it does work.

[BLERDgirl 6,417]

And how many of you were denied and successfully appealed? Any?

There are actually several people on this forum who have appealed and won. Some even had to a peer to peer review. I was fortunate to be approved the first time out but I know from personal experience that appealing insurance company decisions works. I have done them for other things and won. What will not work is having a defeatist attitude such as this:

I have no hope that this will work out. I don't even see the point in trying. No reason to have any confidence in the process or the doctor. I am beside myself. If It was denied wehn I do fit all the qualifications why would it be approved with a face to face. NO hope. Sorry for the type os. I'm too mad to care about correcting them.

if you want this, fight for it.

[Mom0f3inOC 11]

Peer-to-peer scheduled for Tuesday afternoon.

Edited March 5, 2015 by Mom0f3inOC

[BLERDgirl 6,417]

@@Mom0f3inOC - Don't give in attitude is everything. Fight to the very end and make them believe this has to happen!

[Rovobay 920]

appeal or catch a flight to mexico... good luck