How can they deny?

I'm so ticked this morning.  It took me all night to get worked up, but I'm there now!   My husband and I have been told for the past few years by different doctors to get the surgery.  We went to the intro class in April (recommended program by our PCP), and thought it sounded like a great program.  We filled out paperwork, talked to the dietitian at our weight loss clinic a couple of times, and got her's and the doctor's' support there (we've been going there over two years, tried optifast, nutrition classes, etc. with mixed success). 
  Yesterday's mail brings the letter with my husband's denial due to not doing six monthly nutrition visits!  HELLLLOOOOOO we've been going monthly for TWO frickin years.
  We have jumpted through all the hoops the doctor gave us, the insurance person NEVER talked to us about documentation, plus BC/BS has our BILLS for that clinic.  I'm just furious.  I know my denial will be right behind his.   I'm so angry, I feel sorry for the clinic person who gets my call tomorrow. There is a lengthy document for the appeal, but I'm in no mood to do that.

I am so sorry, Mary!!!  It sounds like you and your husband have done more than your share of work to get approved.  I can't imagine how upsetting it was to get that letter.  I am sure it is extremely frustrating.  Hang in there and give 'em hell

I'm so sorry Mary!! But the best thing to do is NOT GIVE UP!! You can do this! Fight them, figure out what went wrong and get the denial form in!

Mary I took this ride (WLS journey) for over a year.  It is nothing less than a roller coaster ride.  Don't give up! Find out what they want and do it to the letter.  They can't deny you in the end.  It may take a little longer, but the extra time is yours to study and research.  I have no doubt that you'll get this done and soon be a loser too.

Mary-

I'm so sorry that this happened.  I agree with the previous posters- DON'T GIVE UP!!  Your wlsclinic should either help or do it for you, it may be as simple as submitting a different form of the paperwork to show the dietary visits.  I know that it is not easy to get that denial letter, but it will all work out- you and Michael are both ready to go forward.

Call me tomorrow if you would like to talk.  I should be home most of the morning.

Reenie

Hi Mary,

Sorry to hear about the denial.

I am wondering if the place that is submitting your documentation didn't request your records from MNCOME.  I had to get MNCOME to fax my records to Park Nicollet.  Once they looked at my history they pulled out the information of the dietician appointments and submitted that information along with their information.  Something to check on.

Tammy

Thanks for the feedback.  I don't plan on giving up - but I'm none too happy about the extra hoops to jump through.  After our initial info session in April, our PCP thought it was a slam-dunk.  But because of the app process, Michael had several appts. and I had a couple to prevent hassles and get things cleared up.  Then we had our psych evals (crock of you-know-what for several reasons) and met with the surgeon and nutritionist.  They told us to do several MORE things - including one that was totally bogus - they told him to see an oncologist, even though his colon cancer was clear since 3 years ago and he had a colonscopy (clean) just a few weeks before.  The doctor said meet with the oncologist, so we tried to set an appt, but they wouldn't see him because he didn't NEED to see them.  Hurdle done.  Then we run into this B.S.  I had an endoscopy, lung tests, etc. etc. that were all clean (which I could've told them) and then this.  Sorry... still ranting a bit.  Its a paperwork glitch nothing more.  But it is our life.  That's what ticks me off.  

I won't give up, but I can see why some do.  This is stupid.

Sweetie, many insurance companies deny a first request as a matter of policy.   Doesn't matter HOW deserving you are, they're going to deny that first submission regardless.

YOU know you've been doing things the way you're supposed to.  Your clinic has records.  Just take this as an annoying obstacle on your way to WLS.  Give them enough proof of need and following protocol, and you will get your approval.  Just have more stic-to-it-iveness than the frickin' insurance company. 

Channel your anger into determination! 

Hang in there sweetie and don't give up!!!!!  Fight the Fight...... we are rooten for ya.........

BCBS requires 6 NUT visits, monthly & consecutive in nature.

If your's were monthly and consecutively, then all the clinic/program needs to do, is call the insurance company and discuss it with them. An official "appeal" does not YET need to be filed.

Don't waste your energy on being upset right now.