Anyone Denied by BCBS FEP - for VSG? Did you appeal, did you win?

BCBS FEP Rep called me yesterday and said they denied my claim.  The reason is it was not medically necessary.   I had the lap band removed and the VSG done at the same time.  However, they approved  the removal of the lap band and said that was medically necessary.

My BMI was 37.  I did have type II diabetes, high blood pressure, high cholestrol, sleep apena, family history of strokes and heart attacks, congested heart failure too.

I don't see why they said it was not medically necessary.  I thought I did qualify.  Besides, they paid for my lap band last year and it was medically necessary then......go figure. 

Is there any of you federal employees with BCBS appeal and did you get your approval after all? 

I'm gathering my information to appeal this.  Also, I have learned there are federal employees in Louisiana, Arizona, Texas who were approved for the VSG.  Why not Oklahoma???

babygirlinokc
































































 

Oh this is a familiar road. I have a BCBS insurance and I went all the way to the second level appeal and was denied. The next step was to pay $150.00 and have my case sent to an outside service. I am still on the fence about all of this. They recommended a different procedure so now I'm looking into  that.  Please let me know how things turn out. PM me if you want to.

Hugs,
Tiffany

Hi Tiffany,

The insurance booklet stated to appeal, then if its still denied, we appeal to the Office of Personnel Management.  I already had my surgery and paid cash for it.  I just wanted to see if BCBS Federal would reimburse me.  I will keep you updated.   Thanks so much for replying to me.  You are the only one that has. 

blessings
babygirlinokc

I dont have BCBS federal, but another federal plan, and I will say that I am PISSED.  They denied me for the revision surgery, but will pay for the removal of the lap band, and I have all types of medical promblems, with a BMI of 49! In my research, aparently the federal government has some time of exclusion on their insurance  policies when it involves second weight loss surgeries/revisions!!!  I am trying to get that part in writting because there is nothing on th eOPm website that mentions that. So, beside having the DR's office appeal,  I have also  appealed to the OPM office of personel mgmt, along with the PA Insurance Commision. Try that, and see what happems!