I WON MY HIGHMARK BCBS (PA) APPEAL!! YIPPEEE!!!!!

I can't believe how excited I am to do this post !!! I keep seeing everyone's approvals & I am so excited to be part of the gang.

I have been calling the insurance company every day.  My file has been w/the 1st Level Appeals Committee since February 4th and every day I hear "it's still being reviewed".  Then, today I called and expected to hear the same thing & the rep said, "It says here that the 1st Level Appeals Committee APPROVED your request on February 14th and a letter was sent out on February 16th" (aka TODAY!)......so, I called Eloise at Centennial to tell her--we teared up--then she transferred me to Dr. Houston's office so that I could schedule my surgery date...(I can't believe I AM ACTUALLY FINALLY APPROVED!!!!)...., but Holly, who is the only one who schedules his surgery dates, was not in today.  My file is on her desk & she is suppos'd to call me tomorrow....Eloise did say that he does surgery on Mondays & Tuesdays & that he has 1 or 2 left for Feb & then has openings in March.....WHAT!?!?!?  OMGosh....February...that's next week.

 WOAH Nelly!! I mean, I need to kick caffeine RIGHT NOW!  Eloise even told me to get all my protein in order & "get my house ready" & everything cleared off my calendar for a while so that I can concentrate on my surgery & recovery.  (Typing this is really an out-of-fat-body experience).....so, um, eh, what the heck to I need.  I need to find out what I need to order & what I need to have in the house for when I get home....I know it is in these stacks of books &, I am sure, the Gastric Bypass Owner's Manual they sent me home with.

Breathe...breathe...breathe, Micheala.  Okay...I just want to take this in for a minute & let myself feel so excited that all the hard work of the appeal paid off & that I did it!! 

Wow...it was August 28, 2008, when I first Google Searched "What is weight loss surgery"  "What kind of doctor does weight loss surgery"....that led me to Centennial's website & then to Dr. Houston's seminar on September 6th....I did my psych eval & NUT eval in September & got a letter from my PCP....of course, I was denied (b/c I didn't have 6 months supervised diet & exercise...go figure....) ...I had 180 days to appeal that denial, so I took five more months to get appointments in (they agreed I had two appointments, but I wanted five more to be safe) and submitted the new docs under the appeal.....and so, it will be a total of 7 months from the first Google search of bariatric surgery to my surgery date....wow!! Life changing!.

xo, Micheala.

Congratulations!!!!  I went through an appeal too and the waiting was the hardest part.  It's such a great feeling to hear "You have been approved" !!   Hopefully you'll get your date soon :-)

Thanks...yes, it is SO great to hear that...I am hoping to have my date scheduled tomorrow.  Your surgery date is just around the corner!!! I bet you are so excited!! Micheala.

Rosie--thanks--what great success you have had...I, hopefully, will follow in your footsteps!! Micheala.

Congrats on your approval.   Holly will call you first thing in the morning.   I got my approval on a wed. afternoon and called and talked to Eloise too... how funny is that.   Holly gave me a date on wed, but called back thursday morning to reschedule it (for a week earlier).   Keep us in the loop when you get your date.  

I am having a different surgery but if you need anything or have any questions please let me know.  

THANK YOU!!!  I can't wait to talk to Holly---Eloise was so sweet...she has been working so closely w/me as I fought my denial & appealed this.  What a great group we are involved with!

I was thinking about you this weekend b/c I had remembered that your surgery was the 24th w/Dr. Houston....so, you better make it through w/flying colors b/c if you don't post soon after I'm switching docs...lol!!!  No, seriously, you are going to do great.  Do they do the DS in two parts?  If so, how far after the 1st surgery do they do the 2nd one?  I can't remember if the DS is the two part surgery or not.

Let me know if you need anything post-surgery...I should be at least a week after you (or more) so I can help!

Good luck!! Micheala.

Can you help m. I am at my 2nd level appeal with BCBS Anthem... Although I don't have the same doctor I need the revision surgery to RNY...PLEASE HELP...MAYBE A COPY OF YOUR APPEAL LETTER..Hi I have Anthem, and the CPT CODE my doctors office used Anthem is saying it's considered Investigational/Experimental... I was wondering if you still had a copy of your1st or 2nd Appeal letter OR IF you could offer any suggestions on how I can get approved....I have a dilated Stoma, Gerd, Reflux, HBP. Lower back problems, my BMI meets the requirements...Also this is for a Revision to RNY...I APPRECIATED ANYTHING YOU CAN HELP WITH.

Micheala - Thanks. I know you are going to do great!

I have a question for ya. Do you like the support group meetings at Centennial? My husband is in the process of negotiating a possible transfer to Franklin, so i'm going to have to find a group to attend.

YES!! I sure do...and we have local support group meeting in Franklin at the library (that I am going to attend for the first time next month).....I can't say enough about Centennial...they have been wonderful to deal with.  You would be in good hands!  If you come this way let me know!  Take care, Micheala.