Insurance denial reasons? BCBS of FL in particular.

I'm eligible on 4/8/11 to send my packet into the insurance co for approval and I am CRAZY nervous that I'll be denied.  I don't know why... maybe we all have these fears.  Anyway, if you were denied, why were you? 

Also, if you have BCBS of FL..... what has your experience been with them?  Were you denied, if so, why? If you were approved, was it a fairly easy process?  Approved the first time you sent your info?

Thanks!
Ginger

Hi Ginger,

I was exactly like you....CRAZY nervous about being denied....and i WAS!!  And so was my daughter!  But I appealled both times and won the appeal on both.  Then, my two sons went through the approval process and they were approved with no problems at all!

I don't have BCBS, I have Aetna.  They have a clinical bulletin that spells out the requirements that you need to meet in order to get approved,  I printed that and used it as my bible and checklist to make sure everything on that list was covered.  I was just like you though...couldn't sleep or think about anything else except scared to death I would get denied.

The reason I was denied is because my surgeon's office turned in my paperwork too soon and I had not finished my physician supervised diet yet!  So, I got denied, continued and completed my pcp supervised diet, filed the appeal, and was approved.

My daughter was denied because they said she did not 'show proof of 2 year history of obesity'  We put together her appeal by submitting 4 years of office notes from our physician showing her BMI being >40 for four years!  She was eventually approved also. 

Then, about four months later, my 2 sons information was submitted for approval an they were both approved within a couple weeks with no trouble at all!

I guess my suggestion to you would be to get a copy of your insurance requirements for what you need to do to to get approved,  Go over it with a fine tooth comb and make sure you have met all of their requirements and that when you (or your physician or surgeon's office) submit for approval, they have that checklist and all the required information is submitted. 

Approvals are usually pretty quick, but if you have to appeal, it can then take up to an additional 30 days and the waiting is nerve wracking!!

Good Luck to you on your approval!  Keep me posted!

Nan

Hi Ginger!!

Sorry to hear that you too were denied by BC?BS of FL. I have that insurance also. Here's what I learned, and maybe you already know this, but...each policy is written differently. Mine for example is employer driven which means my employer picks and chooses what she feels we as her employees will need. Unfortunately for me she does not believe in any sort of bariatric surgery and therefore covers NOTHING. I couldn't even appeal it. I did call BC/BS's 800 # on the back of my card and worked with a wonderful rep who did everything she could to push my request through. Sadly, it all came back to the choices my employer made.  My overall experience with BC/BS was surprisingly nice, they went above and beyond to help me.

Hope this helps.

Stacy

Hi Stacy,
Wow, I am so sorry to hear about your struggles!!  So then it was a total exclusion on the part of the insurance co for your particular employer??  Wow!!  So where does that leave you now in hopes of having surgery? Are you able to self pay (although quite costly) or are you able to get under different insurance (perhaps yours husbands or ??)?

Actually after having this insurance for a year now, I got a bill from a provider I had gone to and it showed my small balance owing after insurance had paid a portion.  In the top right corner I noticed it said BCBS of SC was billed.  So we don't even have BCBS of FL!!!  HA!  Who knew?  When I called the insurance company (from the back of my card) they had read to me all the things I needed to do in order to get approval... and I've done them and we're finally ready to submit to the insurance company (I haven't been denied or approved).  My husband (whom we have insurance through) has been at this job for one year now but the insurance co. requires insurance coverage for 1 year before any major expense (including bariatrics surgery) to be paid.  So I have to wait until 4/8/11 to submit all my paperwork.  I have an appointment on 4/11/11 at 9am to sit down with the insurance girl at the surgen's office and go over everything to make sure we have it all together and then we'll submit that day if everything looks good.  I'm assuming it will all be in order and we'll be able to submit then.

I think it's crazy how every insurance company can be so different with what they require and what they don't require but then you add in how each individual employer can pick and choose what THEY want out of those ins. companies.  CRAZY!!

I really appreciate your insight and I hope you have a way to achieve your goal and your destiny.  Good luck!! 

Ginger