What do I do Now?

I went to see DR. Vitello for a consult back on May 5th. Took 2 weeks for him to get a report back to my PCP. Took the PCP 4 weeks to write his "letter of recommendation" to BCBS. Instead of sending it to BCBS, he sent it to me! It is nothing more than a 1 paragraph letter, advising that I am a candidate for surgery and would benefit from it. I know if I were BCBS, I wouldn't approve me either!!!! so.... What do I do now? I was thinking of putting together my own package of stuff for BCBS.... like getting a copy of my medical records, showing medications (I'm on 8 perscriptions), and writing my own history of my weight loss efforts, and maybe including the report from Dr. Vitello (if I can get it from him). What else would you include? I need some advice here.... let me know what you think.

Hello, John, I am not sure. I went to BTC in Belvidere. They have changed the name now. They took care of everything. It does sound like you have a good idea. I take it BCBS is your insurance? Sending them everything you have should show you need the surgery. Maybe find out your BMI. Well, sorry I wasn't of much help. Good Luck!! Take Care!! Angie

Is it possible the letter is only a copy? I would call your surgeon and ask if he has recvd. the letter, if not I would fax it to him, I would think the surgeons office would be the one to handle the insurance processing. Also, if you think it would help, ask your surgeons office to request your medical records from your PCP so they can send all of it to the insurance. I wouldnt send something to the insurance company myself, they have all sorts of protocalls they need to follow, and you only get a certain number of appeals if they do deny the surgery. Good luck!

Hi Gabrielle, I'm new to this whole website. I read your profile and found it very interesting..I'm going through Suburban Surgical too, Guske is SUPPOSED to be my surgeon. I say SUPPOSED to because Beech Street denied my coverage, saying that I had no co-morbidities, my BMI is 42.7 (less than yours) and they covered you...how did you do that?? I plan on fighting ti until I gt an approval out of them! I called them before I started the whole thing to ask their guidelines on approval and they said that as long as my BMI was over 40, it woudl be approved adn now I'm denied?? That's bogus!

Hi John, I just completed my consult with the surgeon and they told me they would take care of everything concerning the insurance company. All they asked me to do is be pro-active and call the insurance company from time to time. Give your doctors office a call and talk to the insurance person. This is something your surgeon should be doing for you. Good Luck! Take care, Kathy

John- I noticed in your profile that your BC/BS is an HMO. There should be no reason to send anything to your insurance since it is your medical group and not your insurance who will ultimately approve or deny your surgery. At the bottom of your letter is there a cc (carbon copy)? If there is then that is all the people that letter was sent to. I would do this...call your insurance company and ask them what their process is. They will probably tell you that it is out of their hands and up to your medical group. If that is the case then call your medical groups managed care office. Ask them if they have your letter of medical necessity and how soon you can expect a response. I also have BC/BS HMO and I know that this is how its working for me. Hope this helps. Please post an update!