Trying to Stay Calm

I had a dr's appt on tuesday with the WLS surgeon (my results visit), which I think was a little backwards...especially since they had already submitted my application to BCBS of NC, the friday before my visit. At the time of my visit, I found out they submitted the application for a roux-en-y when they knew that I requested to have the lap band. Actually, this doesn't surprise me because during the visit, they tried to convince me to have the roux-en-y instead. Now, in my surgeon's defense, it was the supporting staff that tried to convince me to have the roux-en-y ; not him. Today, I called my insurance to check on the status of my application and was informed that I was denied due to a lack of medically necessary conditions. I then called my doctor's office, and was told that I was denied because insurance was missing qualifying information in the application that was submitted. The office stated that they SHOULD be able to resubmit the application without following the appeal's process.

I am sorry to hear your surgeon's office isn't cooperating. Hopefully they will be able to submit any missing paperwork that is needed and get you approved ASAP. What type of BCBS do you have? I have heard BCBS of NC is pretty accepting of this surgery. 

I'm sorry you are having so much trouble.  Hopefully, with the missing info, you will get approved.  I also have BCBS and I was approved.  PM me if you want more info about my approval process.

Laurie

I just wanted to thank everyone for the kind words.....................and for those who wanted to know the type of ins i have its bcbsnc ppo.......hopefully things will work out....and then i will be in search of angels..........take care  Johnathan

IT IS AMAZING TO ME HOW MANY SURGEONS' OFFICES SUBMIT INCOMPLETE OR ERRONEOUS PAPERWORK.  I ASSURE YOU, BARRING SURGICAL COMPLICATIONS, THIS WILL BE THE MOST DIFFICULT PART OF YOUR JOURNEY! ALL THE BEST,

Be persistant and get what you want. Don't give up! Good Luck Myrtis

The care coordinator with UHC actually encouraged me to have the surgeon submit "whatever he has" and said "if we have to deny it we will state what you are missing"

 

Im like why.. oh why would I want to go through the 30 days twice? TELL ME WHAT TO SEND UGH

Sorry for your trouble, king. I wish you good luck, friend. (Don't even get me started on MY surgeon's office staff!!) Mare

I work w/ BCBS NC on a daily basis....here is what they need: letter of medical nec from the surgeon, your nutrition evaluation, psych evaluation, your TSH level (which is in your labs) and a 4 -5 yr weight history. They are very easy to deal w/. They are very strict on their requirements but if you meet them then they will approve you. :) Now as for the resubmitting w/o using an appeal YES they can. They need to ask for a PCR (basicly a courtesy review). If it's denied again they can request a peer to peer again not having to go through appeal process but tell them to ask the PCR first.  Good luck and stay with it....if you meet the guidelines then you should haven't any problems and you shouldn't have to do anything they should do it for you.

sorry to hear you're having trouble.  if your denial sticks and you want to appeal I'm happy to show you my letter.  I got approved after my first appeal. (was denied because of BMI).