Denials

I have BCBS of Tennessee... I live and work in Georgia and our insurance through my work is through Tennessee.... My surgeons office is an in network provider but is in Georgia. Apparently the office didn't realize my insurance was Tennessee and went by their guidelines. I started my journey in April and I have done everything... I have been denied twice because according to them my 6months of weigh ins/ weightloss program has to be through my PCP and I used my surgeon, and I did my Psycological exam but I didn't have the exact testing done...... So it was denied and next week my surgeon has a peer to peer conference call with the BCBS of TN doctor, to try to get it approved.... Has anyone else had this problems?

I didn't have the same problems with insurance that you have, but my surgeon had to go through a peer to peer to justify my revision surgery and have it approved. Sorry that I can't shed more light on this.

I guess my main question is are peer to peers usually successful?!

Well, it did for me, but I wish that it wasn't so difficult to those people in your particular situation who live in one state with a policy from another. One thought though, when you gave your insurance information to the surgeon's office, why didn't their billing department catch that your policy was in Tennasee? I work in health care as the on site home health RN liaison. Whenever I take a referral for home services, I make sure that it is forwarded to our billing department. It seems like the office staff missed some information, assuming that all policies require the same things. 

That's what I said too! I just hope that with the peer to peer the other doc will see that I did my stuff.... It may not be my PCP with the weigh ins, it was the surgeon, and according to their policy it can't be the surgeon so I hope they over look that.... See that it was medically documented by a physician . They shouldn't hold it against me and not approve me for someone else's mistake 

I hope it works out for you.

I have Care First of MD and had a denial because I was missing a nutrition visit.  My Doctor also had a Peer to Peer with Care First and am awaiting the decision.  I did take the "missing" nutrition class.  Do you know how long it takes to get a response after the Peer to Peer?

I don't know! I thought you got the decision right then..... Let me know how it goes for you!