Peer to Peer Never happened (x post)

I was suppose to have a peer to peer review with BCBS of IL and Dr Roslin today.  The review was suppose to be between the hrs of 11 a.m and 1 pm.  I had an appt with Dr Roslin at 2 pm.  When I got their I was looking to hear some type of news.  (REWIND) I was denied 3x already for the same reason.  No medical record documentation that I was compliant with diet and exercise.  On the last denial letter they decided to put Reason: Lack of Medical Necessity and suggest we have a peer to peer.  (FAST FWRD) Now everything is set and my Dr. is ready to fight for my approval and NO one calls.  (Blank Face).  I just dont get this.  Are you kiddin me?  While I was there Dr. Roslin tried calling them and he told me they were being difficult.  The further and further I go with all of this, the more and more I realize how F@#k up this system is.  Of course I went back to work extremely disappointed but not mad.  I realize it is time to contact my HR dept to speak to the HR rep.  I spoke to a very nice young lady who said she will try her best to help me.  At this point im about to send an appeal letter because this is just BS.  I was trying to wait  things out but it seem like they just want a fight. 

V

So sorry, but if they want a fight, give 'em one. It's so worth it! Keep us updated and good luck!!


Ruby

I have BCBS of MN and the same dang thing happened to me. Dr Maguire waited for the peer to peer call as it was a set appt. BCBS never called at appointed time. Mr Maguire's inusrance gal worked some sort of magic and got it approved without the peer to peer review. It was amazing. I had also called and complained that they did not follow thru and I had spoken to a supervisor at the time. Amazing within 24 hours of it not happening I was suddenly approved. I wasn't too nice on the phone and neither was the docs office !

Hope you can get to the bottom of it. Do NOT give up , as that is what they want you to do.

You got them right where you want them.... they are on the ropes.... Don't give up now....

 KEEP FIGHTING! Don't give them one moment to come up for air.  I know you are a revision and your situation is a little different but here is my appeal letter to BCBS of IL and I was shortly approved there after.

Oh and btw before I went for the DS and thought I wanted an RNY... they had DENIED me for the RNY.  They like to play hardball but keep showing them you are serious.  Call them out on their BS too.

link to my appeal letter:
www.obesityhelp.com/forums/amos/4431226/DS-Appeal-Letter-Sho w-amp-Tell/

Damn girl, I am sorry to hear those ************ed out!  Keep fighting don't give up.  I was hoping to see you post approval!!!  Don't worry it will be soon.

Frankie