My upcoming Appeal for Revision from LB to VSG - BCBS Federal
Hi Everyone, (I already posted this on the Insurance and VSG forums) thought I would include this forum too. I had a revision from Lap Band to VSG.
Yesterday, BCBS Federal called me, the customer rep told me the only reason she could say over the phone about my claims is they were denied because they did not meet criteria. She said if I wanted a more detailed reason that I would have to request that in writing.
I'm working on that right now. I'm going to appeal the denial, I have 6 months to request a reconsideration but I'm not waiting that long.
Yes, Carmalita thanks for your help sista. I'm requesting for a Board Certified Surgeon with Bariatric expertise who will be on the board for my appeal.
My doc wrote a letter of medical neccesity for me. That's whats going on with my claims. I did self -pay and now I'm trying to get reimbursed.
I really regret not insisting my doc to turn in my claim before the surgery. He told me at that time BCBS Federal would deny it. That I would have to do self-pay and then they would re-imburse me not them. Don't really know what the difference is. He said that is what his other patients BCBS Fed did and they were re-imbursed not for the whole amount but some of the cost, maybe 3K to 4K.
Of course, I know some of you had no problem with BCBS Federal. That is my gripe, why do they approve only some FEDs not all. Thanks for listening to me.
Any comments or tips on how to WIN the APPEAL???
babygirlinokc
Yesterday, BCBS Federal called me, the customer rep told me the only reason she could say over the phone about my claims is they were denied because they did not meet criteria. She said if I wanted a more detailed reason that I would have to request that in writing.
I'm working on that right now. I'm going to appeal the denial, I have 6 months to request a reconsideration but I'm not waiting that long.
Yes, Carmalita thanks for your help sista. I'm requesting for a Board Certified Surgeon with Bariatric expertise who will be on the board for my appeal.
My doc wrote a letter of medical neccesity for me. That's whats going on with my claims. I did self -pay and now I'm trying to get reimbursed.
I really regret not insisting my doc to turn in my claim before the surgery. He told me at that time BCBS Federal would deny it. That I would have to do self-pay and then they would re-imburse me not them. Don't really know what the difference is. He said that is what his other patients BCBS Fed did and they were re-imbursed not for the whole amount but some of the cost, maybe 3K to 4K.
Of course, I know some of you had no problem with BCBS Federal. That is my gripe, why do they approve only some FEDs not all. Thanks for listening to me.
Any comments or tips on how to WIN the APPEAL???
babygirlinokc
Virgie Tschirhart
Lap Band - 2008, Sleeve - 2009, RYN - 2017
Started Program Weight July 13, 2017 - 194.2
Before Surgery Weight December 27, 2017 - 185.0
Current Weight - February 2018 - 161.0
The only thing I can say is good luck. I spent 6 months with BCBSTX trying to get the sleeve approved. Went all the way up to the top, with many letters, research data, faxes, etc. And they denied me every time. For giggles I had the dr send in for the RNY, and I was approved in 3 days.
Only a handful of people have been approved for the sleeve thru insurance (or so I have found). Let me know if yours works. I have my RNY scheduled for November, but would really rather have the sleeve.
Only a handful of people have been approved for the sleeve thru insurance (or so I have found). Let me know if yours works. I have my RNY scheduled for November, but would really rather have the sleeve.
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