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I already had my sleeve surgery. I got a "preauthorization" from my insurance (Blue cross/blue shield of TX) for medical necessity (over BMI 40). I just got all the EOBs and every single one of them was denied. When I called the insurance they said that the "insurance" may have approved it, the "plan" didn't as they don't cover Bariatric surgery. He said I should appeal but because employer has that clause it's going to be a tough fight.

Any information you can provide on what to include (or exclude) in the appeal would be great.

I've not gotten a response from the doctors office (except surprise), so I think a peer to peer review is out.

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I appealed with statements from my other doctors making it a medical necessity. If you have other conditions get a letter of medical necessity from each one, cardiologist, General dr, endocrinologist, orthopedic..... My appeal was won fairly quickly.

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@@pb88 - Have you had any luck sorting out your insurance issue? I also have BCBS TX and your post makes me nervous!

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It has been resubmitted by the doctors office and I should know next week if it gets approved or if I have to appeal. Doctor's office said they have never had this situation before. :(

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@@pb88 - Sending good thoughts and prayers your way. Can I ask - which doctor did you use?

Edited by JMill 72

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I had BCBS & I went through the same thing & I learned that it also has something to do with company you work for if its insurance through your job ... & I worked for a non/ profit organization ,Sometime that employer will have that claus in there where none of the plans will cover Bariatric surgery no matter which one u choose PPO,HMO it dnt matter & that's when i dropped ????mines ...

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It's not the insurance company, it's whether the company you work for opts to include bariatric surgery in it;s group policy. If your company does not, I don't know how your surgery would be covered, especially now. I certainly would turn this over to the surgeon's administrative staff though...they should have known this before they operated on you.

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@@pb88 - I've been thinking of you and wondering if you had any luck with your insurance company. Did they end up paying your surgery bills?

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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

        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

      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. 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.

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

    • CaseyP1011

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