dr. 2 dr. with bcbs?

Has anyone had to go through this process at all yet? I have bcbs and have jumped through all of the hoops thrown my way. Initially it was sent for approval, looked at and then sent up higher to be reviewed.. took additional 10 days...... looked at there and then sent up even higher to an outside specialist review. Well this has been going on since Nov and in the mean time I am sitting here with a hiatal hernia in need of repair. (insurance companies can be so non medical! ) so... the gal told me that it was not approved due to inadequate documentation of hernia or stretched gastric pouch. EVEN THOUGH.... the dr sent in a letter stating that an endoscopy was done ect ect and hell there are pictures even! So........ the girl gave me a number to give my gastric surgeon and they would basically set up a time when the dr. could call their dr at the insurance that reviews things and they could discuss things and possibly approve or overturn that decision.
Why dont they do that to begin with. Ugh.!
So has anyone else gone through this dr. 2 dr thing?

Deb,

Don't know if this will help but it's Empire BCBS's medical policy on Bariatric Surgery and it covers revision surgery:

http://www.empireblue.com/medicalpolicies/policies/mp_pw_a053317.htm

hope it helps ....

Best of Luck
Scott

hmm not really what I was looking for. I guess. But ty for the info. Ours is a federal insurance program bc hubby is a federal c.o. but its almost the same. I just wanted to see if anyone else has had the two docs actually talk to each other and what has come of it?

Hi Deb,  I am waiting on BCBS to approve me for a revision.  I still have restriction but yet have still managed to regain 64 lbs back from RNY in 2000.  Originally in June the dr office sent for approval and it was denied.  BCBS said I needed a psych eval and a nutri. eval.  I got these done and they decided they I need to see the nutr. again and they weren't happy with the psych eval, person, this person was recommended by the surgeon and was in my health plan, they said she wasn't licensed.  So now I need to send a letter to BCBS stating that I will stick to the weight loss plan,  do the follow up care, and for me to tell them why I need the surgery.  I am 5ft 3in, have arthirtis in both knees and hips, high blood pressure, sleep apnea, family history of diabeties and weight 275 lbs. and they want to know why I need the surgery.  Oh and I forgot breast cancer survivor.  My doctor was to also do a peer one on one with BCBS doctors also, but the old insurance lady in the office is not there anymore so I think I have to start all over again.  I have been told usually when the drs do the one on one you get approved.  So Good Luck I am sure your approval is just aroulnd the corner.  Sorry to have rattled on about me but wanted you to know what I am going thru.
Marianna