Denied by HMO Blue New England
Ok So I knew that the VSG was not a covered procedure. They now call it investigational. Original submission was for this procedure and it was sent in with my letter, my surgeons letter and with a PCP letter. We also submitted many documents/studies on the sleeve and still denied. So now we go to peer to peer review. My surgeon is not in until April 29th as he is at a convention...ughhhh...so I now have to wait.
Does anyone have any stories of success with peer to peer review?? Thanks