BC/BS has denied my insurance

I am so upset, my surgery is scheduled for July 27th and today the insurance company has denied my approval. They said because I had previous Gastric Surgery. I have written a letter that I will send overnight tomorrow morning, but I don't know how long they will take to decide. It took them 14 days to deney me. The surgery I had was back in 1982 and it did not work very well then. With the tests I have had resently they said that the staple line is completly broken down and that I have a normal sized stomach. I just don't understand! Has anyone else had this happen to them? What did you do? Please help me! Chris

Hi Chris. I haven't had any experience in this, but I just wanted to let you know you are in my thoughts and prayers and hopefully you will be approved this time. If you just need to talk, send me an e-mail, and we can exchange numbers. Hugs, Celia

Hi Chris, I read your profile and saw that your surgeon is Connie Campbell. Is her office assisting you with your appeal? I am so sorry that you have to deal with this! It just isn't fair. You seem like you are a strong person and will fight this, and that is what you must do. Don't give up! The insurance company wants you to do this. Fight them every step of the way! Gather documentation of your previous surgery with supporting facts that the staple line has broken down. Have your surgeon write a letter with medical facts. Please keep us posted. Denise

Hi Denise, Yes my doctor is writing a letter for me, but I would say that she is not doing it willingly. She gives me the impression that this is all a big pain in the butt to her. She even made the comment that she will give it a second thought before she ever agrees to do another revision. She has reamed me out for calling her office to many times. I don't feel that I have but she does I guess! I think she needs to take a class on sensitivity, I know she is busy and that I am not her only patient, but she was less than understanding. It is not my fault that the insurance company acts like this. I don't know why they are allowed to do the things that they do. If I had cancer back in 1982 and needed another operation, they would not put me through all of this stress. I have written a letter with the help of Barbara Thompson's book and sent all the copies of my medical records, GI series , endoscopy, etc. I have done everything I can think of, now I guess I just have to set back and wait until they make a decision. If this does not go through this time, I think I will get an lawyer to help me. I have already racked up about $2,000 in medical bill just getting all of the tests, and the consultations. I don't know what I will do if they refuse to pay for these procedures. I am really upset over this whole process, I just don't know what to do! Chris

Chris, I am so sorry that you are dealing with this. I know you already have a surgeon chosen, but it seems she isn't offering the help you need. Have you considered switching surgeons? I ADORE my surgeon and his entire team. The office coordinator is an absolute angel and I can not imagine her not assisting patients with denials. In fact, their office has NEVER had a denial that wasn't overturned. Everyone who attempted to get surgery through his office had surgery. My surgeon is Dr. Drinkwater, and like I said, he is phenominal. Would you consider giving them a call? Perhaps they can help? The way I go on about Dr. Drinkwater you would think I worked for him, LOL. I swear to you I don't, I just have nothing but awesome things to say. I have had a truely excellent experience with them. His office staff are fantastic! Why don't you call, ask for Jen, explain your situation and see what she says. It doesn't hurt, right? It may be the best call you ever made!! Their phone number is 577-5757. Best of luck, Chris! Denise

Christine, I agree with Denise. Maybe you need a new perspective & an opinion form another surgeon may help. He can also tell you if he thinks it would be hard to get approval. Don't give up! Good luck, Pat

Christine, I just read your update on your profile. I was sad to hear how you have been treated by the surgeon & her office. I avoided seeking treatment by that practice because they are part of CMC & my family has had the worst problems there. We almost lost our Mom d/t a surgeon's error (Not Dr Campbell) & then she received some of the worst care I have ever seen. It is important to get treatment where you can be treated like a valuable human being. When we tried to bring our concerns to the administration of the hospital we received poor responses. Both my sister & I are health professionals & have worked at CMC in the past. I have to say from my recent experiences I wouldn't let them treat anyone I care about. Maybe this was a good thing for you in the long run.Seek care from other surgeons & see if things go better. My thoughts are with you. Let me know how things are going for you. Pat