DENIED IN LESS THAN 6 HRS!!!!

Hello Everyone,

I just got a call from a really nice Rep at BCBSIL, in less than 6 hrs of submitting.

She just told me that I was denied based upon DS being experimental. I also had her fax me a copy of the letter....so its true I was denied!

I called the surgeons office and the insurance coordinator was very shock that it was review soooo fast, and denied. She will be out of the office on Monday, but will have the Dr. submit a letter of appeal.

I think I should start up a letter tooo. Does anyone have a really GREAT letter I can use with my appeal? Please let me know.

I am now frustrated....I know BC will cover the RNY, but thats not the procedure I want or the surgeon suggested.

Please send me any appeal letters that you have used, that got you approved that you don't mind me using bits and pieces.

Sincerely,

Tracy, there is a gal onthe insurance forum, and sometimes on the main board that deals with insurance problems.

Have you talked to the gastric person at your insurance group? to find out what Dr.s they will deal with and procedures. Try that first thing Monday morning. You may have to change Dr. or procedure.

We have all dealtwith insurance claims and denials of some sort. My BCBC wouldn't cover any weight loss surgery until 2007, evenn though other programs in the same company did.

You didn't get denied because of your own agenda. just that they don't cover the DS .


Lisa

A lot of people told you this would probably happen in your earlier posts.  You really should have expected them to say no, then if you got approved you would have been pleasantly surprised and now you'd probably be less upset.

I know that doesn't make it feel any better.  Sorry it happened so fast, but at least you're not wondering any longer.

You're on the right track to stop being angry and use your head and get info on how others have successfully appealed to BCBS of IL to get approved.

Just post to the insurance & DS (& maybe IL) forums and see what kind of answers you get in a few days.  Other forums probably won't be of any help because they're off topic.

Even if you eventually lose your insurance company battle it could still be worth pursuing self pay to get DS.  I would have pursued self pay fro the DS if I had been forced to  - it just would have taken years longer.