Anyone with Empire BCBS?

I have Empire BlueCross and BlueShield and they approved my surgery no problem. I thought I was one of the lucky ones and I guess I was, in a way. However, now that I have no restriction and my surgeon agrees that it's time for a fill, they refuse to pay! They sent me a letter saying "Insufficient clinical to certify request, therefore denied." To quote the SpongeBob movie...

What the scallop? (WTS)

Thank God I have managed to keep off the 22 pounds that I've lost. But you know it's just a matter of time. I am really frustrated with BCBS. I call and get transferred all over the place, and no one will tell me how to get approved! There is an appeal process but I wonder how successful that will be. Do any of you have any ideas or suggestions for me?

I almost wish they had never approved the surgery. What is the point of having the band placed if I can't get fills? I could have dieted without risking my life on an operating table, thank you very much!

I am sorry for the issues you are experiencing with the follow-up portion to your bariatric surgery. Of course, it is reasonable for you to expect your fills to be covered since getting fills is part of the entire process.  Based on the notice that you received, it's fairly clear that your doctor's billing office did not submit sufficient information to substantiate your insurance company's paying for the fill.  The best bet is to talk with your doctor's billing office to have it resubmit the request with additional and substantial medical information so that you can go ahead and finish your therapy.  Usually, the office can review your plan documents to ascertain the specific information that your insurance company will require in order to approve therapies. You can go the route of appeals, but as long your doctor's office continues to submit insufficient information, you will continue to receive the same denial.  Additionally, appeals can be a lengthy process, and I think you have demonstrated more than your share of patience thus far. I hope I was able to answer your questions.

Thank you Xavier. According to my surgeon's office they submitted all kinds of information but it was still not enough. I wonder if maybe it was sent to the wrong department or something. I will keep trying to get to the bottom of it. Thanks for your support!