So frustrated...
denied on 2 appeals for Vertical Sleeve
Spent the last year and a half going through
all the tests and criteria for Indepependance Blue Cross.
We decide to just go for RNY...
now they say I dont meet the weight loss program criteria and
have put it "on hold". Not only did I do a medical
management with my doctor, I did 8 weeks at the
Stunkard Weight Management Program at PENN and lost weight.
I just went online and read the medical policy and it says this:
Consultation and instruction by an eligible healthcare provider on low calorie diets and an exercise program based on the individual's capability .
It says nothing about how long or any other criteria.
Do I call IBX and say I am reading your medical policy on line and it says....
any suggestions??
Spent the last year and a half going through
all the tests and criteria for Indepependance Blue Cross.
We decide to just go for RNY...
now they say I dont meet the weight loss program criteria and
have put it "on hold". Not only did I do a medical
management with my doctor, I did 8 weeks at the
Stunkard Weight Management Program at PENN and lost weight.
I just went online and read the medical policy and it says this:
Consultation and instruction by an eligible healthcare provider on low calorie diets and an exercise program based on the individual's capability .
It says nothing about how long or any other criteria.
Do I call IBX and say I am reading your medical policy on line and it says....
any suggestions??
I just went through an appeal with IBX for plastics albeit I was denied the 2nd go round.
What you need to do is contact your surgeons office and ask them if they will handle your appeal. If so you will need to call IBX and request a HIPPA form so that your surgeons office can handle your appeal. If you prefer you can represent yourself, altough you most likely will have better luck if they do it.
Once that is done and you appoint them to represent you IBX has 15 days to give you an answer.
Best of luck.
What you need to do is contact your surgeons office and ask them if they will handle your appeal. If so you will need to call IBX and request a HIPPA form so that your surgeons office can handle your appeal. If you prefer you can represent yourself, altough you most likely will have better luck if they do it.
Once that is done and you appoint them to represent you IBX has 15 days to give you an answer.
Best of luck.
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