Got my new denial letter!!!
I don't understand how they can now change their reason for denial. If there first reason was "patient successful lost weight but has regained" and that was incorrect so I sent them 3 years worth of clinical notes with my documented weights to prove I have not been a technical successfull WLS lose nor have I regained weight. Then shouldn't I have been approved? How can they NOW say that my upper endoscopy and upper GI do not show complications from the original surgery...when as I clearly stated in page 2 of my letter all the complications. I have an enlarged stoma and enlarged pouch.
Then they also mention that the reports are "not very recent" well duh I'm pointing out this happened a long time ago hence the 2 year stall in my weight loss....BTW 1 report isn't more than 1 year old...given the original submission was made in June it was quite recent. Do they want to pay for NEW tests...will they approve me then?!?!?!?!?!
So then the letter goes on to tell me of my next level appeal rights. It says that I or my rep. have the right to request assistance from a BCBS employee with preparing the appeal. Then the number given to ask all questions regarding the letter is the regular customer service number.
So of course I call it...luckily I get Susan who has always been nice and helpful....and I tell her that I'm glad I got her for those reasons....alas she tells me she has "limited access to information" and does not know what the letter is referring to...she puts me on hold to ask her supervisor. She comes back her supervisor doesn't know either and they were unable to contact any one in the appeals department...they will have to call me back later. Now why give me a number where no one knows about what you just told me in the letter???? 
The lady at ICUBA (our benefits admin) has e-mailed me back but she has just basically copied people at BCBS Highmark asking them to check into things but they have not responded...I'm about to e-mail the 2 ladied at Highmark...since I see their addresses from the e-mail and ask about all this.....
The lady at ICUBA (our benefits admin) has e-mailed me back but she has just basically copied people at BCBS Highmark asking them to check into things but they have not responded...I'm about to e-mail the 2 ladied at Highmark...since I see their addresses from the e-mail and ask about all this..... I have Lipedema and Lymphedema. I also have a passion for Obesity and Health Insurance Advocacy.
Blog: born2lbfat.com Facebook: Born2lbFat Twitter: @born2lbfat
I understand about the letter. I received on Tues. 2 letters one saying I am in first appeals and the other saying I was denied. I was denied due to incomplete paperwork. Which was faxed to them on the 10th so I don't know why it is now in appeals. They have 15 calendar days to reply if not I'm automatically approved. I am waiting to see what happens. I have already downloaded the form from NYS dept of insurance of my 2nd appeal if necessary.
What really bothers me is how they say 15 days to notify me how do they prove that? They can date the letter but that doesn't mean it is sent out on time.
This is so frustrating, and we know they do this for us to give up but I'm so pissed that giving up is not an option.
Good luck with getting the correct information you need. Keep at them.
Joy
Most Active
Recent Topics
My insurance will not pay for my excess skin that hang down to my knees
Hockeymom87 · 0 replies · 608 views
Hockeymom87 · 0 replies · 608 views
