Anthem Blue Cross of CA PPO - appeal proccess

Just have to vent... I've been calling Anthem every single day since I got my first denial letter - to check the status of my appeal.  Each time - "everything is in review proccess and we will have a decision in 30 days".   Today - 30 days later - I called and they try to tell me my doctors office didn't submitt all my paperwork that they needed so they have no choice but to DENY me again.  BULL****!  They faxed it and I faxed it - you ****** got it!  So... before I ***** out the rep that told me this - I ask to speak to somebody who gets paid to hear me go off.  She transfers me to a voicemail.   Of course - I'm livid and go off on this person's voicemail.   To my utter surprise the lady called me back 4 mintues later to explain what the situation was.   Apparently they needed a few more pieces of info from my doctors office that accordingly to Anthem didn't arrive by the "deadline".  Since she was able to check on all of it today - she said she would leave my case open for "conditional" appeal review.  Said it would only take a few more days.  OMG - I couldn't thank her enough.  I sort of felt bad by flipping out on her VM but honestly - I don't think she would have cared if I hadn't shown anger.

Just have to vent... my emotions are all over the place today.  I think I got the stomatch virus that's going around and with my 30 days of patiently waiting for an anwser... swwh - I need some rest.

I have Anthem Blue Cross PPO of CA.  I was denied originally due to VSG being "investigational".  

Thanks for listening to me vent...

- To Be Me Again

If you were orginally denied the VSG being investigational were you ever told that you can file an appeal with the Dept of Managed Health Care in the state of California and 95% of them that are appealed to them are overturned when insurance deny investigational on VSG and Duodenal Switch.   If you would like additional information on the process please send me a PM message and I will be glad to forward that information to you

I am have just started the process of getting approval for my VSG. I know that  my Anthem Blue Cross Blue Shield isn't current;y covering it but I have seen on the message boards ways to do an apeal. Can you give me a bit of information on the best way to do that? Also I don't know if it makes a diffrence but even though they are a Calf. company I reside in Flordia. Is the Apeal proccess the same for me? Help!

 I have some info on my page about IMR decisions overturning denials of VSG. Is Anthem Blue Cross the same as Blue Cross of CA? If it is you are very fortunate because then the DMHC would have jurisdiction over your insurance and you could file an IMR with the DMHC after you've exhausted all your internal appeals through your insurance. I think you'd be better off getting the denial now and requesting a IMR from the DMHC. They are very pro WLS. Best ofluck to you.
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i CAN'T THANK YOU ENOUGH FOR THIS INFO!!! I just recieved my offical denial again due to investigational and have filed an IMR today.  You are such a good friend - one of my many OH friends.

Keep on sharing!

Thank you kindly,

- To Be Me Again