BlueShield of CA HMO - Appeal - APPROVAL or DENIAL

Lori A.
on 9/22/08 3:47 am - rosamond, CA

Hello,
I was denied thur my medical group. No big surprize there, Needless to say I'm in the middle of Appealing thur Blueshield of CA HMO, It has been two week since I started the appeal , they told me it could take up to 30 days. I'm just wanting if anyone has appealed this insurance comany and if so, were you approved or denied and how long did it take. Thanks

Monica P.
on 9/22/08 4:02 am - Long Beach, CA

RNY on 07/19/07 with

I'm sorry about your denial, but don't give up it's not over yet! I'm glad you filed an appeal.

Yes, by state law Blue Shield has 30 days to respond to your appeal. If they do not, you have the legal right to go to the DMHC (Department of Managed HealthCare)

Every case is different and so is every insurer. Depending on your situation you may get approved...I know there are some HMOs who automatically deny surgery at the first request and often change thier mind when someone appeals.

Most people do not know that appeals are even possible!

Good luck!

Now if you are going to win any battle you have to do one thing. You have to make the mind run the body. Never let the body tell the mind what to do. The body will always give up. It is always tired in the morning, noon, and night. But the body is never tired if the mind is not tired."
- George S. Patton, U.S. Army General, 1912 Olympian

Rachelq
on 9/23/08 9:51 am - Laguna Niguel, CA

RNY on 04/27/04 with

I had my surgery through blue cross of CA Hmo. Thier criteria for surgery was pretty basic (bmi over 40 or over 35 with obesity related comorbids). They didn't have a 6mo diet requirement. Before that I had cigna, my medical group was opposed to me having surgery and turned my paper work in wrong and with limited info on my bmi and co-morbids. Once I appealed to cigna, I was approved with out a problem.

I would check directly with blue shield for the wording they use for WLS eligibility.

Wishing you well.

Rachel

nascar24n48
on 9/24/08 3:43 am

RNY on 04/16/08

Check my blog. I have a copy of the letter I wished I had sent from day 1 Certified mail. I also have Blue Shield HMO and had issues with two medical groups. Constant delays, missing forms, and no formal denial from the group just excuses. Finally learned how to play the game by sending this letter CERTIFIED mail to PCP, Medical Group and the Insurance. Watch how fast they get things moving! It worked for me!!

Lori A.
on 9/24/08 3:51 am - rosamond, CA

RNY on 10/27/08

Thanks for the reply, yes i saw your letter and used some of it for my appeal letter.....LOL, I already summited it to Blueshield of Ca, how long did it take to get approved once you summited your appeal?

BlueShield of CA HMO - Appeal - APPROVAL or DENIAL

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BlueShield of CA HMO - Appeal - APPROVAL or DENIAL