Denied BC/BS Iowa/ can u help w/ appeal?

bsmith56 · May 8, 2008

:cursing: I was scheduled to have my first consultation w/ my surgeon on Tuesday, but on Saturday I got a denial letter from my BC/BS of Iowa. I called the Bariatric Center and spoke w/ the nurse. She suggested I fill out the appeal (which was included w/ the denial letter), and maybe talk to my doctor to see if she would have any suggestions.

Does any one have an appeal letter that worked?

I really need this surgery....I feel like I don't have any other options. I have struggled for many years......but up and down. I am again working on my weight loss on my own. I will give it all I have.

Please help me if you can. Thanks. :redface:

Savedbygrace · May 8, 2008

What was the reason for denial? Not medically necessary? Your Policy?

xgrl · May 8, 2008

I'm not sure about a appeal letter but what did you have for documents and such like 6th month diet? letters from dietition? main doctor? pshycitrist? and so on.... I heard that letters from these people can help as well as just more documentation. I haven't summited yet I'm on Month 4 of my 6 month diet. I'd be interested to know what happens keep us informed

iowamom · May 8, 2008

I would send the appeal.

Good luck and hang in there.

Edited May 9, 2008 by iowamom

bsmith56 · May 9, 2008

I was denied because "not medically necessary". Have BMI of 42, but no co-morbidities. Both parents now have diabetes related to their weight. I have bad knees and back related to my weight. Have been this weight for nearly 5 years and have tried most everything under the sun. I need this tool to help "shut my hunger off".

Sorry, I answered your question and more.

My insurance does pay for the surgery, but my denial was because it was not medically necessary.

Thanks.

bsmith56 · May 9, 2008

The bariactric center submitted all my records. I did a psych eval through the center. I'm sure that was submitted as well.

I am going through the center w/ Genesis Medical Center in Davenport, IA.

xgrl · May 9, 2008

I was thinking do you have any other mediacal problems such as gerd, depression, asthma or basically anything else that you can think of that might be effected by your weight there are some studies out there that says that obesity can make Migraines worse. I'm trying to think of things to add so they can see that it is medically necessary ummm planter facitis (or however you spell it) high cholestoral, gall bladder stones, arthritis, gout, skin infections or skin tags, lnfertility, stress incontinance just think of any health problems you've had over the years that you have mentioned at the doctor or been treated for...because i've figured out that alot more than I thought Healthwise is realated to my obesity. Let me know how it goes....:thumbup:

bsmith56 · May 9, 2008

Because I haven't had any health problems, I haven't been to the doctor much...except w/ my kids. I did have plantar faceitis (sp), but not recently. I have been to the chiropractor alot....can those records be used? I will have my chiro write a letter of support, because she has encouraged me many times to lose weight to help maintain my spinal/bone health. I think I am healthy because I go to the chiropractor regularly....not even a cold. Also have good genes, but also have my parents "fat" genes.

Anyone ever have a chiropractor write a letter of support?

Thanks.

xgrl · May 9, 2008

hmmm it's not a bad idea to have the chiro write a letter of support anything helps. I can't really think of anything else just stay on it and keep fighting it, they'll eventually have to give in! :thumbup: