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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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Go To Topic Listing Insurance & Financing

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    • Alisa_S

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      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
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      1. LeighaTR

        LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

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      Officially here for a long time, not just a good time💪
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