what to do now?

denied 6/7/07 peer to peer 6/14/07.. not overturned.. what to do? linda

nosey questions here... LOL what insurance do you have? why were you denied? I have BCBS of IL and was denied. because not enough information from my PCP about my 6 month diet.. and PCP would only write some crappy letter. (started my 2nd 6month diet agian as of the 14th of June).. my Peer to Peer Review is either today 6/19 or next tuesday 6/26. I would love to see what everyone tells you to do.. since i am in that boat too.

i have aetna. 1st  they told me it was because they didnt have enough info, then they said it wasnt med nessacery. my doc did a peer to opeer and it still wasnt overturned.. i feel like im at  a wall.. i have nothing else to do.

You can always appeal there decision. Insurance companies are more likely to deny you than approve you... just to make you jump thru more hoops just to see if you really want it done. I say fight the good fight and hopefully they will change their minds. Susan

GOOD MORNING MY EMAIL ADDRESS  IS [email protected].. I JUST FOUND OUT THIS MORNIHG THAT MY PEER TO PEER DIDNT EVEN HAPPEN THAT THE TIME LIMIT RAN OUT.. IM SO AGGRIVATED.. THANKS FOR YOUR HELP LINDA

Paul, I am about to start the 6 month plan with my PCP. I do have coverage for LAP-Band after the 6 month plan is complete. I want to get it right the first time. Would you mind sending me the forms that you used for your 6 month plan? I would be very greatful. Ali Orlando, FL [email protected]

I have aetna also and was denied and also had the peer to peer and that was also denied.  I have put in an appeal and just waiting for that.  They told me that I was under the weight in the last 5 years so they denied me....nice right??  I guess I just have to gain more weight and keep it on for 5 years for them to approve me.... Keep trying... BTW, on the peer to peer they hung up on my Dr.....they were very professional...

hi so that is the same thing they told me.. well the first was it wasnt med nessity and the next one was that my bmi fell below 40.. this is agrivating.. then they did the peer to peer and it still was not overturned...ugh!!!!...im healthy other than my weight. no comorbitities(whatever)lol)..so i dont know what to do? i guess they are going to appeal.. i dunno.

The year that your BMI fell below 40 was it below 40 the entire year (meaning on all records)?

I had the same problem.  Luckily, my surgeon anticipated the denial and did not submit the lower weights.  If you plan to appeal don't send the lower weights, unless of course you don't have higher weights for that same year.

Good luck.