Sleevesters Survey-Please Help
Sleevesters, I need your help. Did BCBS (Athens) approve your VSG? If so, please answer:
Did they approve it? If so, how many rounds of denial/appeal did you go through? What was your appeal technique? Was your request for a straight VSG?....or for a 2 part DS....or some other request?
Although BC of CA PPO has agreed to pay for the removal of my band, I am in the midst of appealing my denial for a VSG. They even denied my doctors request for a RNY even though I have a BMI of 42 w/ diagnosed sleep apnea and other obesity related issues. I was self-pay for my band, so it's not like they are paying for "another" WLS.
I am arguing that a presidence has been set by Blue Cross as they have approved several VSGs. So, "experimental" or not, they have no reason to deny my request if they do indeed pay for the surgery and my doc deemed it the best surgery for me.
If you were approved, please respond.
Thank you so much for your time.
Did they approve it? If so, how many rounds of denial/appeal did you go through? What was your appeal technique? Was your request for a straight VSG?....or for a 2 part DS....or some other request?
Although BC of CA PPO has agreed to pay for the removal of my band, I am in the midst of appealing my denial for a VSG. They even denied my doctors request for a RNY even though I have a BMI of 42 w/ diagnosed sleep apnea and other obesity related issues. I was self-pay for my band, so it's not like they are paying for "another" WLS.
I am arguing that a presidence has been set by Blue Cross as they have approved several VSGs. So, "experimental" or not, they have no reason to deny my request if they do indeed pay for the surgery and my doc deemed it the best surgery for me.
If you were approved, please respond.
Thank you so much for your time.
On May 17, 2009 at 7:52 PM Pacific Time, Band2VSG wrote:
Sleevesters, I need your help. Did BCBS (Athens) approve your VSG? If so, please answer:Did they approve it? If so, how many rounds of denial/appeal did you go through? What was your appeal technique? Was your request for a straight VSG?....or for a 2 part DS....or some other request?
Although BC of CA PPO has agreed to pay for the removal of my band, I am in the midst of appealing my denial for a VSG. They even denied my doctors request for a RNY even though I have a BMI of 42 w/ diagnosed sleep apnea and other obesity related issues. I was self-pay for my band, so it's not like they are paying for "another" WLS.
I am arguing that a presidence has been set by Blue Cross as they have approved several VSGs. So, "experimental" or not, they have no reason to deny my request if they do indeed pay for the surgery and my doc deemed it the best surgery for me.
If you were approved, please respond.
Thank you so much for your time.
It's more a matter of if your employer is paying the WLS premium. WLS and Major Medical don't always go hand in hand. You have to have WLS benefits. If you do have WLS benefits with your BMI that should be enough.
What is the specific reason for denying your revision?
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