Appeal!! they are going to do a peer review?? Does this work

Joe_C
on 3/21/11 3:51 am
I have BCBS of Minnesota.  My doctor submitted for approval then I was denied.  I wrote an appeal letter with doctor visit notes and dates and copies of what they had written all were noting the soars and rashes.  That appeal was returned denied also and with this appeal they sent me information to do an out of office appeal to the state.  I have everything addressed in my letter as what they require to have the surgery but was denied.  I have now called and asked for a peer to peer review with my doctor and they are lining it up.  Is this a good sign, has anyone gone through a peer to peer review??  Should I still be hopeful?

   >>>Approved!!! Surgery 10-19-09<<<
              Starting an improved new me

        
mzhuny
on 3/21/11 5:48 am - Humble, TX
Be hopeful! I had a peer review for my gastric Bypass and they approved it in 15 minutes.
    
Joe_C
on 3/21/11 6:24 am

Thanks,  I don't think they can reject all the proceedures that I am requesting.

   >>>Approved!!! Surgery 10-19-09<<<
              Starting an improved new me

        
katsparks
on 3/21/11 9:02 am - Auburn, CA
What all are you requesting coverage for?
                                   
SW:270         GW: 125         CW:104(and still losing)
New Goal Weight: Whereever my body feels most comfortable and stops losing.

Abdominoplasty with Dr. Scott Green: 10/11/11
Joe_C
on 3/22/11 3:34 am

Arms, Panny, Inner thigh, and upper chest. 

   >>>Approved!!! Surgery 10-19-09<<<
              Starting an improved new me

        
levittown_loser
on 3/21/11 10:30 am - Levittown, PA
On March 21, 2011 at 10:51 AM Pacific Time, Joe_C wrote:
I have BCBS of Minnesota.  My doctor submitted for approval then I was denied.  I wrote an appeal letter with doctor visit notes and dates and copies of what they had written all were noting the soars and rashes.  That appeal was returned denied also and with this appeal they sent me information to do an out of office appeal to the state.  I have everything addressed in my letter as what they require to have the surgery but was denied.  I have now called and asked for a peer to peer review with my doctor and they are lining it up.  Is this a good sign, has anyone gone through a peer to peer review??  Should I still be hopeful?
I would think the peer to peer gives you a higher chance of getting it approved.  I wish you luck!!   Do you have a back up plan?    Hey fellow ds'r ... you should join our male plastics group here.  Info in my siggy.

HW 341/SW 309/CW 169/GW 190   172 lb. loss with my DS -  Subscribe to me on YouTube!
Plastics with Dr. Sauceda 1-11-11 Lower Body Lift, Thigh Lift, Upper Body Lift, Arm Lift and Male Breast Reduction


If you are a MALE and are interested in MALE PLASTICS AFTER WLS click to join our OH Group!


Joe_C
on 3/22/11 3:38 am
Thanks, I will check it out.  I plan on apealing for ever, but maybe I will have my doctor just ask for the panny and upper chest if I keep getting denied.  I have doctor visits and prescriptions for everything that they require prior to surgery so my doctor and I don't understand what I am missing.  So I am quite confident that I will get something done.

   >>>Approved!!! Surgery 10-19-09<<<
              Starting an improved new me

        
katsparks
on 3/22/11 8:02 am - Auburn, CA
Best of luck to you!
                                   
SW:270         GW: 125         CW:104(and still losing)
New Goal Weight: Whereever my body feels most comfortable and stops losing.

Abdominoplasty with Dr. Scott Green: 10/11/11
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