Found out why I was denied

And it was not for medical necessity. I was denied because when BCBS contacted April in Dr. Appel's office and requested the additional information last week, she sent back to them exactly what they already had on file. SO now she's out today (how convenient) and I am scrambling trying to get my thyroid levels from my PCP and the NUTRITIONIST eval, not psych, as April had told me. I made that psych. rewrite her letter for NOTHING. I am so pissed I cannot see straight. I have sent an email to Walter Lindstrom. I only get one appeal and I don't want Dr. Appel's office screwing it up! Kelle

Try not to get discouraged. It took me 5 months to get approved with BCBS. My surgery date is Monday, 5-10. My doctors office and BCBS kept playing games with my information. I finally went to my doctors office got the information and faxed it to BCBS myself, and it worked! They received it on a Friday, and I was approved on the following Tuesday.

My doctor's office has said I don't have access to my file...that they can only give me what I filled out for them, not what they've received from other doctors. Is that true? Kelle

I guess every doctors office have their own rules & regulations. My doctor's office had had so many problems with BCBS, they let me handle it. I was lucky.

I dont think that that is exactally true. When I filled out my paperwork yesterday for my new PCP It had HIPPA regs in there, and who they can release info to,and how much info can be released. I have went to several of my old doctors notes for approval for this surgery and my old dr's gave them to me. I would double check, I am not real sure.,but ask about the New HIPPA Law. It has something to do with the release of your medical records. Good Luck Diane

no that is not true your file is your business ...No one else has the right to get a copie or see it with out your permission but you have the rights to your medical history and files ....You have the right to get copies of anything or the whole thing if you ask for it ....they can not with hold anything from you ...cause if they had that right they could have put anything in there and you would never know like you weight 100 and your 5'10 or soemthing crazy liek that ....so you sooo have a right and you have a right at least to get the info you need to send to BCBS and then i would fax it over yourself ...Like i have copies of everything that got sent to Duncans since i dont trust anyone to fax anything and then i had a copie and i did not have to keep going back and forth to eveyone i saw ....Good Luck i have faith you will get this straightened out ...Just take a deep breath ...and relax cause when your freaking ( as i would be too right now ) you will tend to make mistakes ....So just Breath !!!!!! Laura

It seems like something I've seen before. I don't think you will have a problem-just give them what they want. As far as your medical records, with all this new Hippa(sp) law stuff-they can't keep your records from you. You need to check on that.

Kelle, are you sure you just get one appeal? with my bcbs, they say if dr. files it it is one appeal, but if i do it on my own i get 3..... good luck kiwani

TRY ME AT WORK AGIAN YOU HAVE THE NUMBER i CANT FIND THE # YOU LEFT I WILL BE AT MY DESK BY 11AM

Hey Nat, I'm not at work today. I'll try to give you a call tomorrow. I know at this point that BCBS is playing games with me and that's the source of my problems. I got a number from Dionne for an actual person at BCBS and gave that to my surgeon's office. April from Dr. Appel's is as mad as I am about all this mess, if not more so. She said she's going to refax everything (again) then blow this ladies phone up until she confirms she's received everything. Maybe a resolution is in sight! Kelle