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Denied - Peer to Peer review



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Got the dreaded phone call today, my pre determination was denied. I have BCBS of TX. When told the reason for the denial there were a lot of doctor notes missing. They needed notes explaining how my band has failed. My doctor is doing a peer to peer review tomorrow. I feel completely hopeless and helpless. Has anyone had success with this?

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Sounds like it's your doctor's fault and your doctor's responsibility to fix. Part of being a doctor is jumping through (or having your staff jump through) the hoops that their client's insurance puts in front of them. Don't feel helpless a lot of times these things all get worked out pretty quickly.

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11 hours ago, Brttnyj89 said:

Got the dreaded phone call today, my pre determination was denied. I have BCBS of TX. When told the reason for the denial there were a lot of doctor notes missing. They needed notes explaining how my band has failed. My doctor is doing a peer to peer review tomorrow. I feel completely hopeless and helpless. Has anyone had success with this?

Don't worry. The Dr should be able to to clear it all up with the medical director during the peer to peer.

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Got the dreaded phone call today, my pre determination was denied. I have BCBS of TX. When told the reason for the denial there were a lot of doctor notes missing. They needed notes explaining how my band has failed. My doctor is doing a peer to peer review tomorrow. I feel completely hopeless and helpless. Has anyone had success with this?

Sending positive vibes your way in hopes it gets resolved quickly!


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On 4/5/2018 at 12:59 AM, shelleycakes said:

Don't worry. The Dr should be able to to clear it all up with the medical director during the peer to peer.

I wish that this happened. However it was denied.

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On 4/6/2018 at 5:26 AM, Brttnyj89 said:

I wish that this happened. However it was denied.

Sorry to hear that. Try not to let that get you down. So what now, has your surgeon come up with a new action plan to work towards an approval?

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8 hours ago, shelleycakes said:

Sorry to hear that. Try not to let that get you down. So what now, has your surgeon come up with a new action plan to work towards an approval?

So now I’m on my on with an appeal. They wouldn’t even help me with the appeal. I’ve talked with Lindstorm Obesity Advocacy.

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