DENIED IN LESS THAN 6 HRS!!!
I just got a call from a really nice Rep at BCBSIL, in less than 6 hrs of submitting.
She just told me that I was denied based upon DS being experimental. I also had her fax me a copy of the letter....so its true I was denied!
I called the surgeons office and the insurance coordinator was very shock that it was review soooo fast, and denied. She will be out of the office on Monday, but will have the Dr. submit a letter of appeal.
I think I should start up a letter tooo. Does anyone have a really GREAT letter I can use with my appeal? Please let me know.
I am now frustrated....I know BC will cover the RNY, but thats not the procedure I want or the surgeon suggested.
Please send me any appeal letters that you have used, that got you approved that you don't mind me using bits and pieces.
Sincerely,
Datrace
I focus not on my disabilty; my focus is on my ABILITIES.
(Dedee, 2009)
My hearing impairment ENABLES me, not disables me.
(Dedee, 2008)
~Dedee
So sorry, that really sucks. It sounds like denial as policy. In your favor, ds is around long enough to easily prove it is an accepted treatment. Perhaps someone on your state board with the same insurer can share how they won on appeal? Good luck.
MSW Roux-En-Y Gastric Bypass: Eat sensibly & enjoy moderation
Links: Are you a compulsive eater? for help OA meets on-line Keep Coming Back, One Day At a Time Overeaters Anonymous
LV'N MY RNY. WORKING FOR ME BECAUSE I WORK FOR IT.
Do they have an exclusion for DS on your policy? I am surprised your surgeon did not check to see if DS was covered before they sent in your papers.
**** I AM AN OH SUPPORT GROUP LEADER ****
WHY I CHOSE DS: No dumping. Highest percentage of weight loss, Best long term results, Won't regain weight! Eat normal sized meals, 96% diabeties, 90% high blood pressure, 80% sleep apnea cured. I MY DS!
My doctor told me to stop having intimate dinners for four unless there were three other people. ~Orson Wells
