Officially denied

I shouldn't be surprised, I did expect it but still disheartening.  BCBS of NC (State employee's plan) denied VSG because they consider it to be investigational. I have not gotten my Dear John letter yet but my surgeon's office called me. So I need your help.!! What do I put in the appeal letter? I have some research info from the internet but what do you think would be helpful? I have BCBS federal , MD, DC and Carefirst policies showing they do approve it. Should I get letters from my PCP, nut and/or psych?

I am cross refering this on the VSG, Main and Insurance boards.

Thanks a heap!!!!!

Well darnit.  I'm so sorry.  I understand that you have researched and found the right surgery for YOU and that is what you want!  I can't even begin to imagine someone telling me that I can't have the RNY, but that they will offer me "X"...ummm, NO!!!  The RNY is the perfect surgery for me, thank you very much, and I don't want anything else...wouldn't do anything else!!!  Since I don't have any experience with appeals, I can't offer you any advice on that note.  Just wanted to let you know that I'm sorry, understand where you are coming from, and wish you the very best in getting the surgery you need and want! 

please check on the main board. There is one lady that is a insurance guru that may be able to help you out.

I know that Blue Cross Blue Shields of NC is very strict. I work for a County and I have blue cross.

Good luck

Tamara

i will give a little bit of advice. My wife got rejected when she tried to get her RNY. She called up her doctor and asked her if she did not mind if my wife wrote the letter and let the doc sign it. Her doc was tickled cause it meant less work. Then my wife sat down and made her case as if she was the doctor writing it. It may be worth it but the insurance company reversed their decision. Basically my wife wrote it up in such a way that she was about on deaths door and in reality she had one foot on the threshold. It is just an idea that may help you mainly because you know yourself alot better than the best medical people do. It would be worth a shot. Just write it like you are the doc.

Unfortunately, I had to delete this post due to privacy concerns.