Appeal to Carefirst BCBS - Need help!!

 HEllo Everyone!  Happy 4th of July Weekend!!! I need to lose about 170lbs, get off my BP meds and treat my infertility so after years of soul searching I decided RNY is the only tool that will help me bet the battle I have ahd with my body and health for YEARS.   So in May of this year my insurance (CareFirst BCBS - PPO) denied my request for RNY surgery by Bayview-John Hopkins (Dr. Steele) due to not having 6 month of diet history in the past two years.  I am not 170 lbs over weight becasue I have not tried to diet.  So I have been going to my PCP and weigh****cher so here is what I have finally documented from JC and WW: In 2006 - Jenny Craig - I have documented 3 Months of weigh-ins (August, Sept, Oct) and  In 2008 - WW  -I have documented 3 month (April, May, June) and will continue to go until I get approved.  Also, my PCP has put me on medication for high blood pressure, and I am taking metformin for insulin resistance related to PCOS.  My question is - do I write the appeal myself and mail it t the insurance company or do I give Dr. Steele's office this information and have them submit??? I feel more in control if I do it but at the same token, want to make sure I get approved.   Anyone have experience writting an appeal letter? If so, I can use some words of wisdom and what to do and not to do.   Thanks,  Iman

Inman make sure you go everymonth for exactly 6 months and then just have the Dr refile for approval they basically denied for additional information not a complete denial.  Hope this inforation helps Vicki

I too have Carefirst (BCBS) out of MD.  I used my WW records from 2006/2007 for my approval.  I submitted my food journals and my bank statements (I used the monthly pass) and was approved on Tuesday (it was submitted on Thursday).  I did have 6 consecutive months so I am not sure if that is the difference but I don't understand why they denied you.  My surgeon said if we had to appeal (which I am so thankful that we didn't) that I should let his office do it because in his experience many insurance companies only allow one appeal (including mine) and that if I didn't get everything just right I would be denied again.  My heart goes out to you---feel free to send me a private email if you want to discuss this more. Kerri

Iman,

   May I ask who your bcbs is through? What company do you work for?

Ok then, I would say let the DR handle the appeal. BUT before you just hand it over- call the ins company and ask them to send you IN WRITING exactly what they require.

HTH!

Hi Ladies - Thank you all!!! I will get my diaries in check and let you know.

OH!  I work for Erickson Communities and that is I have my insurance through...why do you ask?? :-)

 

Just curious, as it seems some BCBS go so easy and others are not.

Best wishes to a positive outcome with your appeal.