Surgeons office says they won't appeal VSG to Wellmark??

I went last week to the seminar for Dr. Eibes in Des Moines. I knew that my insurer which is Wellmark BCBS considers the sleeve investigational but I was under the impression that I could appeal and that the Dr's office would help out with that.

Much to my surprise and dismay the insurance lady there told me they don't appeal to Wellmark BCBS because "they never win". She never said how many times they had done appeals with them or anything like that so I really have no idea.

So I'm just wondering what the heck I should do. I know it's only a matter of time before insurance companies get their heads out of their collective asses and start approving the sleeve but I don't want to wait anymore. I fell like I've been waiting forever already.

And what really ****** me off is the fact that we pay about four hundred dollars a month for an insurance policy that gets to dictate what I can and cannot do with my body. It's just such a bunch of crap.

Anybody have any suggestions on what to do next? I know I certainly won't drive hours to a seminar anymore till I talk to someone on the staff specificaly about my insurance company!! Gosh what a total freaking bummer this has been to say the least!

I would file my own appeal.  In fact I was preparing my appeal when I found out my doctors office was doing it for me.  There is a lot of information on here about how to appeal and what to write.  Good luck to you.  I can't say you will win but I certainly would not be ready to give up.

This probably sounds really stupid but I guess I didn't really think about just doing it myself. If that's the case then would I just go ahead and schedule a consult and then go from there? I feel stupid asking this but I just truly don't know!

Another stupid question is if I am denied, even after appealing...will this have any effect on my being able to have the sleeve in the future if and when it's covered?

Hi-
Sorry you are having to go through all of this...what a pain. Eventually insurance companies will cover the sleeve, but it may take awhile. Trying for the appeal will not affect your negatively further down the line at all - so don't worry about that. Since you are submtting your own appeal, I would use the support and guidance given by the OAC - Obesity Action Coaltion, they have an awesome part of their website that shows you step by step how to do your own appeal. You can go there by using this link http://www.obesityaction.org/advocacytools/insurance/appeali ngadeniedclaim.php

Good luck!

Thank you so much BillieK , I will look into that.

Most surgeon office will not appeal cases for patients, its up to the patient to appeal but I do appeals for individuals on OH and I also do them for our patients at our local Bariatric center, if you need help feel free to email me at  [email protected]

Hi Vicki! Actually you gave me some great information awhile back about insurance and the sleeve. I guess I was thought that the Dr's office helped out with the appeal process. The vibe I got from the Dr's office was that they just didn't want to even deal with someone with Wellmark who wanted the sleeve. Maybe I just took them the wrong way but that's how I took it.

I'm not sure if I should just schedule a consult anyway and then go from there or what?

By the way Vicki if you have any new helpful information I'd love to know about it. It was back in June when I had talked with you about it before. Thanks for all you do for everyone by the way!