Hello Everyone,

I got my papers Oct 24 saying I was denied due to the fact I did not meet my 6 months weight loss criteria threw Blue Care Network. Something is not right because my doctors office just called me Oct 23 saying they had just faxed my medical records over to the specialist to be processed and the denial papers I got were dated for Oct 20 something cannot be right. My doctor told me Oct 6 that she had everything covered so that my paperwork would go threw. My question to the forum is when I speak to the doctor and especially Blue Care Network what do I need to say and do so I can get this done correctly and reapply and get the lapband because I really need and want this? Are they any some hinters on how to lose a little weight so they can see that I am trying to get the approval I am looking for? Can anyone help me with the appeal process? Is there anything that I am overlooking I have only been working on getting the Lapband since Aug 19 and I know there is still alot of information I am missing out on? I just want to know the ins and outs of the insurance company tactics to deny a person of feeling better. HELP ME PLEASE!

Sincerely,

Bunni Love:smile2:

Did they just fax medical records over or did you actually have a 6 month supervised diet plan with a physician that is documented in notes? I had to have the 6 consecutive months documented and those had to be sent with the request for surgery.

If you met their criteria they may have missed the documentation. When my papers were submitted I got a quick refusal because I "did not meet weight loss criteria". I had a documented 6 month supervised diet and lost 9% of my body weight so that did not make sense. When I called to ask what their weight loss criteria was the woman I talked to on the phone saw the error and resubmitted everything and I was approved in 48 hours. So, yes they can make errors and it is our job to make sure we submit charts that meet all of the insurance criteria and then make sure they actually read it all! Good luck.

This is exactly why I went to mexico and got it done. The critera is so much easier and there is only a week or two waiting. Unfortunately I had to pay for it myself but $8000 was not a bad price for the excellent care I received. Now paying the loan off is a bummer but my insurance wanted me to wait some 6 month thing, forget it. I am fat and time is wasting. If they keep denying you, check out your options, trust me. I did and it was the best thing I ever did.

BCN is a total PITA. If you have continued issues with them, I'd contact one of the lawyers through obesityhelp.