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Denied.

gebbiabn

By gebbiabn, in Insurance & Financing

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gebbiabn    34

gebbiabn
Posted

So, I called BCBS on my way to work this morning (Well, yesterday morning, Wednesday). I got denied. They said the only reason was that they didn't have proof of where I've been compliant with diet and exercise after my Lapband surgery. I then called my surgeons office and the RN, Helen, that deals with insurance stuff said she is aware, she already received the denial. She said she feels I've been very compliant and is going to review my file again. Then she said she'll decide whether she will request them to reconsider, or whether to have Dr. Miles himself do a peer to peer review.. I'm bummed... But trying to stay in good spirits that it will all work out in the end. Helen told me that she's super busy this week, but that she will get to it the first of next week and will let me know what's going on. She told me that her and Dr. Miles wouldn't have submitted my case if they didn't feel I'd been compliant. So at least it seems they're going to fight for me. :/

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Cervidae    2,389

Cervidae
Posted

At least you have good people on your side working hard on your behalf. Best of luck, sorry about your denial. That's really tough. :( Crossing my fingers and sending good vibes your way.

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The Candidate    3,215

The Candidate
Posted

Hang onto that hope. I've seen a lot of denials here that eventually turned into approvals. Best of luck!

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gebbiabn    34

gebbiabn
Posted

Thank you. I will keep fighting, even though I don't really know what I'm doing!! lol luckily my surgeons office is helping me with the next steps and didn't just give up with the denial.

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Blueeyes66    11

Blueeyes66
Posted

:( Ive been denied toooo......its so aggravating. I went to a diet clinic for 3 months and they wont accept it because it was a nurse practioner that I saw.

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gebbiabn    34

gebbiabn
Posted

:( Ive been denied toooo......its so aggravating. I went to a diet clinic for 3 months and they wont accept it because it was a nurse practioner that I saw.

Omg! Seriously?! That is ridiculous. They'll find any reason not to approve us.

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ImBringingLisaBack RNY    70

ImBringingLisaBack RNY
Posted

Please don't give up! I've been on a roller coaster ride for the last 5 months of this process and I can tell you I'm very very happy I didn't give up!! I was denied 2 xs in a week until my dr did a peer to peer and they approved me in less than 5 minutes of him calling them!

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gebbiabn    34

gebbiabn
Posted

Please don't give up! I've been on a roller coaster ride for the last 5 months of this process and I can tell you I'm very very happy I didn't give up!! I was denied 2 xs in a week until my dr did a peer to peer and they approved me in less than 5 minutes of him calling them!

My surgeon is supposed to be doing a peer to peer review by next week with BCBSNC. Him and the nurse, Helen, don't think we should appeal. They don't feel we'll get an approval that way, so they want to go straight to the p2p. I'm so nervous :/

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The Candidate    3,215

The Candidate
Posted

I hope you get it overturned. Stay positive and good luck!

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Blueeyes66    11

Blueeyes66
Posted

Im to the point of giving up......its so depressing. I am in so much pain right now from my back that I cant sleep. I dont know what the problem is with my ins. company....Ive been denied once and my surgeons office has sent in for a review and Ive not heard anything yet. But, I'm not getting my hopes up like I did the first time. Looks like if a person has comorbidities of hyperlipademea, high blood pressure, degenerative disc disease and a BMI over 40, and a family history of congestive heart failure, high blood pressure, diabeties, and cancer that that would be enough.......but evidently not. :( I'm 5'1" weigh 230 and my knees are swollen and feel hot all the time. they make a clicking and grinding sound and I know thats not what they are supposed to do. My daily activities has almost come to a complete stop due to the pain.....And I'm still sittin here WAITING. I just wish they would approve it so I can have my life back. I have a little Granddaughter due in March and if I dont get approved I wont get to run and play with her when shes old enough. I'm crossing my fingers it goes thru this time.......

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Daisee68    2,493

Daisee68
Posted

@@Blueeyes66 - don't give up. I was just talking to another poster who filed an appeal with Cigna and got approved.

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Blueeyes66    11

Blueeyes66
Posted

I dont even know how to file an appeal...other than to tell them how my everyday life is complicated and painful from the problems I have from being over weight. :unsure:

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gebbiabn    34

gebbiabn
Posted

@@kaoson2 I did get approved with the peer to peer review! I had my surgery 11/30/15, band to RNY revision. I've lost 47lbs so far. It's a daily struggle, but worth it so far!

Sent from my iPhone using the BariatricPal App

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