NEW and NEEDS LOTTTTS of Help

Hello, To all of the Lap veterans, its a pleasure to be on the site. I thank God for this and praying that I get approved on the first try. Does anyone have any ideas on how to write the predetermination letters? I've seen the sample, but I have my primary insurance (First Health) and secondary (BCBS) and both don't pay for weight loss. First Health has a Bariatric exclusion. I'd like some coaching on how to write a good letter the first time out so that I have a good chance that the reviewer will approve. Let me know your thoughts. God Bless, PC

Pam - I am sorry I do not have any answers to your questions but I wanted to welcome you to the board, wish you luck and let you know that we are ALMOST neighbors. We are about 15 minutes from each other. That being said, if you get approved or even before if you have any surgery related questions that I can help you with I am here for you. I wish I knew more about insurance but I do not. Good luck and best wishes on a successful journey!!! Nancy

Nancy, Thanks so much for your encouragment. I truly appreciate it. I will keep you posted. Blessings, PC

I do not know anything about First Health - but have had LOTS of experiance with BCBS. I assume you mean BCBS of ILL? Is it a PPO - or HMO? It also depends on YOUR company and what type of plan they are on. couldn't your doctors help you write the letter? You would think they would have lots of experiance in that catagory. I know My plan on BCBS did NOT cover the lap band. They considered it experimental. They DID cover the RNY - but you had to jump through ALL thier hoops! I completed everything they asked and they still did not approve becuase it was not worded correctly. With your primary having an exclusion and knowing BCBS - I would suggest you not try to do this on your own. Use the staff at your surgeons office to help you - and even get your HR rep at your company who deals with the insurance on board if possible. YOu might want to even consider having a lawyer who is familar with this process help. I can almost guarentee that you will get denied the first time. It is the insurance companies way of hoping you will just go away. Do not give up- get a CLEAR reason for the denial and keep going at it. It took me about a year and half to fight with insurance companies, but I am three months out now and loving life! Hang in there.

Peppermint, Thanks for your words. I am trusting God that I will supply all the information needed to get approved on the first try. I've seen it happen, so I'm hoping that I can get the same approval. I'm also hopeful that because I have 2 insurances, it'll be a little easier. I have the BCBS PPO. I've seen it approved first time out. I have the appt today with my primary doctor, I am going to ask his nurse if she could assist me. I'll have them submit it and then when I meet with the surgeon I'll get his assistance as well. I won't send the letter out by myself, I'm just going to try and be proactive and give my own detailed letter so that the doctors office has less to do. I have two young ladies, one at my church and one at my job that had the gastric bypass. So they will oversee my letter writing process and I'll give it to the doctor to take from there. Thanks Much Blessings, PC