Help/advice needed

 Hey guys & gals!
Ok...here goes...I got my 2nd denial letter today for my panniculectomy
I'm very frustrated and plan on calling my Gastric Bypass surgeon's office tomorrow
I am 2 years 1 month out from RNY
(I have BCBS of NC)
They are denying based on the fact that my GB Doc's records show my starting pre-op weight as 255 (this was my weight AFTER the pre surgery diet in which I lost 20 lbs, so my true starting weight should be 275) My current weight is ~165-168 depending on what day of the month it is...and has been that weight since about 9 months after RNY. So they are saying Denied b/c haven't lost greater than 100 lbs. Their 2nd reason is not having been at a stable weight for 6 months?! Um excuse me, I've been the same weight since 9 months out of surgery! 3rd reason for denial is no infectious complications (and i haven't had any that I'm aware of! and I think I'd be aware of them)

I'm SO frustrated! Today is my birthday and to get that denial letter just super soured my mood!

My PS office said the next step they'll be taking is a Peer to Peer review/appeal??

Any advice?

From what I've gathered on this board and the folks in my bariatric group it's those that stay the course and fight the good fight and become a thorn in their side that are the ones the get it approved. I tried 3 times and failed and had 1 appeal left but gave up and just wanted it done couldn't stand emotional roller coaster anymore.

I hope you stick it out and win one for the good guys & girls,

Bubba

It sounds like #3 is going to get you. If you do not have any documented history of infections or complications from infections, and that is one of their criteria, it sounds like you are out of luck. Start saving your money.

Laura

 Thanks guys for your advice...I'll keep praying and I know the next step is that my Plastic Surgeon is going to be doing a Peer to Peer meeting next with BCBS to plead my case too...It's just crazy that I meet 3 out of their 4 requirements, but since I haven't had a skin infection (which could cause an infection and higher risk plastic surgery) that may take it out :(
I'll keep my fingers crossed!

Welcome to my world. I never had any issues with infections either. I  also had BC/BS of NC at the time. I was turned down and had to pay out of pocket. I took out a home equity loan to pay for mine, and it was well worth it. I wish you luck with everything, and I know this post is late, so maybe you have already succeded in having the surgery.