Help on Insurance rejection

I have been rejected by Anthem Blue Cross (1st Letter) and am wondering about any suggestions anyone has for me regarding what to do next???????????

I haven't been submitted yet however I show a great interest in your quest. For insurance reasons, I have chosen Dr. Opie. I am wondering if you spoke to Anthem Blue Cross first for what criteria they are looking for? I have CIGNA and they have been very helpful with the kind of documentation they are looking for. CIGNA won't cover another Surgery Center in Lenexa or Mission but will at OMC. I meet the BMI/Weight cir****tances but arent sure about the rest.  I wanted to attend Dr. Opie's November Seminar but it was full. I am scheduled to attend December seminar and will proceed after that. Did your letter state why you were denied? Do you know what documentation Dr. Opie's office submitted? I'm am sorry that you got that letter. I'm just trying to determine if its what was provided, the facility, or the insurance company in general? I hope you don't give up. I have heard rejections to be fairly common. Please keep in touch and I wish you all the best. I am eager to follow your journey!

Cigan covered my surgery at Shawnee Mission Medical Center.

Thanks Jeannee for the information. That is good info to know. I am scheduled to attend the December Seminar at OMC. I am used to great services at OMC as I've delievered two kids there and have has other outpatient procedures there. I think it will come down on who has the availability I really don't want to wait a year to get banded. I will call Cigna tomorrow and inquire about SMMC. Malley in Mission and the Bariatric facility in Lenexa werent covered- however, I've heard good outcomes from both places.

You're a wealth of knowledge and sound like you're doing great- keep it up!

I was just on Cigna's website...thought you would find this interesting!!!  The hospital put in their claim for the surgery.  Here are the results!  (does NOT include surgeon...just surgery and hospital charges!) Total claim submitted    $30,914.50 Total paid by Cigna          $5,027.98 My co-pay                              $558.65

sorry to stick my nose in as I haven't read all the posts but curious.   Is the total for lap band submitted to insurance?   Was there any complications?    If so,  wow,  what a difference with personal pay.  There has to be something I am missing. sorry if there is. I am self pay and will be having surgery Dec. 3 at Tallgrass in Topeka.  I wasn't sure between Olatha.  It is just closer by about an 1hr.

Nope, there were no complications, however I did stay in the hospital overnite because I live in Wichita.  The charges are just outrageous.  For example:

drugs (only one of 25 they submitted!)  charge of $560.75      ins paid $60.05

supplies?!?!?!  get this....3 submitted       $ 579.00     4,023.00     10,211.00   

insurance paid                                                     62.00         430.00       3,369.63

operating room        charge of   $6,594.00      ins paid   706.11

recovery room          charge of    $3,389.00      ins paid  362.91

I don't know why they hike the prices up so high to bill insurance, unless some insurance are willing to pay that much.  Seems crazy to me! 

Well, I guess today truly IS another day because my denial was reversed, and I am scheduled for surgery Dec. 10th!!!!  My original denial was supposedly because they deemed the surgery not medically necessary although in my book the only criteria is the BMI...  I have other comorbidities-PCOS, hypertension, osteoarthritis,... but they didn't seem to think it was enough...  However, the letter sent to me indicated I was being rejected for a repeat gastric bypass (even though I've never had the 1st one!!!).   I'm not sure what tipped the scales around in my favor, but certainly the phone calls-probably numbering several per day from Becky (and myself) probably helped.  I went in and gave Becky a big hug today.  Now I have to work on getting my job to grant me medical leave (they don't think this qualifies)--here we go again-- The only thing I could think of that I didn't have great documentation on would be offical weight loss programs because there just weren't any to document... Hope this helps and I'd love to keep in touch with you!!

Congratulations!  The hardest part is always getting through the red tape!  Be sure to keep us informed on your progress!

Thanks!  I sure will!  Debbie