Knock the wind out of me!!!

Dr Rodriguez's office sent the paperwork off on june 17 to blue cross blue shield of alabama on july 2nd i received a letter stating that the medical review staff has "determined that we are unable to provide benefits for the following procedure: gastric restrictive procedure for 120 cm (long limb) cpt codes 43847. According to the terms of this patient's contract, this procedure would be considered investigational and not covered." Now what happens????

Renee, That doesn't sound right to me. I would call BCBS up and ask them does your policy cover this. It could be in the way your doctor worded it (the code used). I know they have approved lot's of their patients for the bypass. Check all of your information and policy you have and call them and ask questions. Call everyday if that's the case until you get an answer.

THANK YOU ALL SO MUCH THE DOCTOR SENT ANOTHER REQUEST IN AND THEY APPROVED MY SURGERY AND I GOT A CALL 7-23 AND 4:55PM FROM BC/BS..AGAIN THANK YOU ALL-RENEE

Hello Renee, I used to work for an insurance company and it sounds like the Dr.'s office needs to use a different cpt code. The ins.companies can only go by the code the Dr.'s send in. First see if the Dr can choose a different code that better decribes the surgery and then check w/ the ins. to see if the new codes are codes that would be approved. If the Dr. refuses to change the code, then maybe he just needs to send in additional documentation verifying the surgery's benefits. Hope this helps, Natalie

THANK YOU ALL SO MUCH THE DOCTOR SENT ANOTHER REQUEST IN AND THEY APPROVED MY SURGERY AND I GOT A CALL 7-23 AND 4:55PM FROM BC/BS..AGAIN THANK YOU ALL-RENEE

Diagnosis Code 278.01 Procedure Code 43846).

THANK YOU ALL SO MUCH THE DOCTOR SENT ANOTHER REQUEST IN AND THEY APPROVED MY SURGERY AND I GOT A CALL 7-23 AND 4:55PM FROM BC/BS..AGAIN THANK YOU ALL-RENEE