Insurance issues
I need some advice-
I had my gastric bypass in june of 02. It worked wonders for me; since though i have regained 90l bs of my original 160lbs weight loss.
I went and saw my Doctor about a potential revision. The Doctor explained to me without a "fistula" it would be virtually impossible for me to get insurance to pay for the revision surgery.
i had an EEG and the test showed guess what- a Fistula... i have been very excited thinking insurance approval was all but a formality.
today i got a letter from my insurance company denying the request for the revision. Basically it was denied because "records do not indicate member met all screening criteria for intial procedure..."
With my 90lbs i have developed diabetes and high blood pressure. I am going to see a cardiologist next week to boot....
Anyone have any advice, suggestions, ideas? HELP!!!! i was crushed when i read the denial letter today and dont know what to do! I have called the Doctor in hopes of meeting with him within the next couple days.
Thanks in advance!
M
I had my gastric bypass in june of 02. It worked wonders for me; since though i have regained 90l bs of my original 160lbs weight loss.
I went and saw my Doctor about a potential revision. The Doctor explained to me without a "fistula" it would be virtually impossible for me to get insurance to pay for the revision surgery.
i had an EEG and the test showed guess what- a Fistula... i have been very excited thinking insurance approval was all but a formality.
today i got a letter from my insurance company denying the request for the revision. Basically it was denied because "records do not indicate member met all screening criteria for intial procedure..."
With my 90lbs i have developed diabetes and high blood pressure. I am going to see a cardiologist next week to boot....
Anyone have any advice, suggestions, ideas? HELP!!!! i was crushed when i read the denial letter today and dont know what to do! I have called the Doctor in hopes of meeting with him within the next couple days.
Thanks in advance!
M
I'm not sure who your insurance is with, but I initially had the same "rejection letter due to not meeting all screening criteria for initial procedure" when I applied for revision. I looked up their "surgical policies" on line and found that my insurer (MedCost at that time) had used the criteria for INITIAL surgery to reject my REVISION surgery. I printed off the policies and took them to the doctor's office. Using that information, they re-submitted my application for revision surgery and it was approved within 2 weeks. Try doing that research and see if it helps! Best wishes!
Your quote is almost exactly what my denial letter said......didn't meet the criteria for the initial surgery.
So, go to BCBS of Illinois main website (you should be able to access their information via a website provided by your employer) and check out their policies for "Surgery for Morbid Obesity." They should have a separate policy for INITIAL and a separate policy for REVISION.
I think you'll find what you need there. Print out copies of every thing you find on their website---keep one copy for yourself and take another to your doctor's office.
Best wishes and hang in there!
So, go to BCBS of Illinois main website (you should be able to access their information via a website provided by your employer) and check out their policies for "Surgery for Morbid Obesity." They should have a separate policy for INITIAL and a separate policy for REVISION.
I think you'll find what you need there. Print out copies of every thing you find on their website---keep one copy for yourself and take another to your doctor's office.
Best wishes and hang in there!
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