Appeal Letter To BCBS

Well I sent all the stuff off to the Dr office and when I talked to the nurse she said I might want to think about starting my appeal letter to BCBS of IL I don't know what to say. Why does this have to be so hard? The nurse said it will take up to 30 days before I get a answer then if they say no I can write a appeal letter then what???? I am feeling defeated by all of this...

Why does the nurse feel you might get rejected.  Do you meet the medical criteria?

Seriously?!  Gee... she sure is an optimist, huh?  Is there a reason she thinks you will be denied? Have you fulfilled all the criteria your insurance requires? 

Honestly this seems pretty silly to me. You can't write an appeal letter before you know why you were denied. The letter is meant to address the reasons you're denied. So you'll have no clue what to write until they tell you what the problem is.  And usually an appeal letter isn't even necessary with a denial. Usually a denial comes when there's a piece or two of missing information and all that's needed is submitting those pieces and letting them re-review the file.

As long as you know you have submitted everything that's required and that you meet the criteria for approval... then there's nothing to worry about. Just wait to hear from BCBS.

You'll be fine. Don't let the stupidity of a nurse get you down. This is an exciting time - embrace it!

Well my BMI is only 37 and for BCBS to approve you have to have 2 co issues well I am on meds for  my cholesterol but that will not count. I did 90 days of a Dr supervised diet went to phyc Dr and a nutritionist. The nurse said if you do not have all the stuff they want they will deny you and most of the time if you write a letter they just approve it cause they don't want to pay the cost to fight it the more people that get involved the more it costs the insurance company.. I think I will just wait and see they say up to 30 days before they tell you that will put it around thanksgiving...

 She's right that if you don't meet the criteria you will be denied. But a letter won't "automatically" get you approved though. If you don't meet the criteria, they won't approve you. period.  In fact, they never should have submitted your paperwor****il it was 100% complete - that's irresponsible on the doctor's part because you don't have an unlimited amount of times you can submit for approval. The rules are there for a reason and you can't get around them.

High cholesterol IS a co-morbidity, so that counts. What other issues do you have that have not yet been diagnosed and documented in your chart.  High blood pressure? sleep apnea? pre-diabetes? heart disease? asthma or respiratory problems? joint problems? incontinence?  You're better off figuring out what "else" you have going on and getting it documented right away -- and start getting treated for it.  Because it sounds like that's the only way you're going to get approved for WLS. 

I am going to Dr Verseman he has a nurse that all she dose is deal with insurance so that is her world if you know what I mean.Borgess is a center of excellence (I think that's what they call it) for this type of surgery. I am sure she has dealt with all of this many times in the past... I just hope they approve me now its a waiting game.

I guess I'm VERY Lucky!!!
I have BCBS of MI and did not even have to submit- auto approval!!! 
Co-Morbidities:
type 2 diabetes treated w/ metformin 2x a day
HBP lisinopril 2 a day
High Cholesterol Fenfetrol (somethign like that) 1x a day

I have some joint pain & acid reflux... but nothing too horrid.  My BMI is 44, I am 5ft 11 inches and 320 lbs. 

I cant wait to get on the losers bench