VSG thru BC BS of MO
Your Bariatric Surgeon's office should handle all of that for you. If you have contacted your insurance customer service rep on your own and was told you have a Bariatric exclusion in your policy then you are flat out of luck. Or if you do not meet their requirements, such as high enough BMI, then once again you are flat out of luck. You didn't mention why you are wanting insight on an appeal so I am just guessing why. But those are the 2 most common reasons for denials in my office.
If I can be of any more general help please feel free to ask. I am on the other side of Mo. than you so I don't have any recommendations as far as a surgeon, sorry.
Wishing you all the best,
Connie
If I can be of any more general help please feel free to ask. I am on the other side of Mo. than you so I don't have any recommendations as far as a surgeon, sorry.
Wishing you all the best,
Connie
I know we have bariatric coverage, I also think I meet the requirements. I am very close to a 40 BMI with some co morbidities and family history of comorbidities.
VSG has been hit or miss with BC BS in general, because it can be considered "Investigational". So I was just trying to stay ahead of the game and get my ducks in a row.
I really want to get the sleeve so if I have to do it private pay, I will figure out how to get it done. I also would consider going to KC if necessary, I mean thats only 3.5 hours away.
Do the docs offices do all the pre-auths and appeals?
VSG has been hit or miss with BC BS in general, because it can be considered "Investigational". So I was just trying to stay ahead of the game and get my ducks in a row.
I really want to get the sleeve so if I have to do it private pay, I will figure out how to get it done. I also would consider going to KC if necessary, I mean thats only 3.5 hours away.
Do the docs offices do all the pre-auths and appeals?
I am glad you know you have coverage, generally that is the biggest hurdle. My office has had some success in getting BCBS to cover the Sleeve but like you said it is not consistently approved yet. You could call your insurance customer service rep and ask. They should be able to tell you one way or the other. Might levitate some of your worry.
My Surgeons have a self pay promotion for the Sleeve going on for $11,999.00. But I am not sure they would agree to a patient living so far away. They usually want you to live closer for at least the first year. But of course I can't speak for them. Hopefully you will be able to find something similar within your area.
As far as the money part goes there are several in my area that has used SurgicalLoans.com. I know nothing about it other than I see the paperwork go through my office. But might be something you would want to check out. Certainly would be a lot easier if your insurance covers it of course.
As far as the doctor's office handling the pre-auth and appeals... yes they do and if they don't find another bariatric practice fast. Cause that would be a big red flag. That is part of the administration cost included in the surgeon's fees. And no surgeon worth a darn is going to allow their patients to confirm who or where their payment is coming from.
Keep us updated with your progress and if we can help in anyway,
Connie
My Surgeons have a self pay promotion for the Sleeve going on for $11,999.00. But I am not sure they would agree to a patient living so far away. They usually want you to live closer for at least the first year. But of course I can't speak for them. Hopefully you will be able to find something similar within your area.
As far as the money part goes there are several in my area that has used SurgicalLoans.com. I know nothing about it other than I see the paperwork go through my office. But might be something you would want to check out. Certainly would be a lot easier if your insurance covers it of course.
As far as the doctor's office handling the pre-auth and appeals... yes they do and if they don't find another bariatric practice fast. Cause that would be a big red flag. That is part of the administration cost included in the surgeon's fees. And no surgeon worth a darn is going to allow their patients to confirm who or where their payment is coming from.
Keep us updated with your progress and if we can help in anyway,
Connie
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