Help my insurance denied me
i'm trying to have revision from lap band to DS and insurance company (BC BS of IL) denied me. They said I had to prove that my band had slipped or eroded and provide proof of why it needed to be surgically repaired. I don't have any major malfunction but it just doesn't work for me!!!!
Hasanyone gottoen approved for a revision fthat has BCBS insurance? How did you get approved? Did you have to prove anything?
I need answers fast. I lost my job and can only afford a month maybe two of cobra.
I'm so depressed I could just cry!
Hasanyone gottoen approved for a revision fthat has BCBS insurance? How did you get approved? Did you have to prove anything?
I need answers fast. I lost my job and can only afford a month maybe two of cobra.
I'm so depressed I could just cry!
Grandma Cindy
326/286/140 (start/current/goal)
Hi, Please post this on the ds board, if you are willing to do some research and fighting, there are a couple of ladies over there that help in this fight. They know how to fight and win in a lot of cases.
Good luck, and good for you for going for the ds!! great choice, don't settle short!
shele
LiFeLoNg hEaLtH iS mY GoAl
RNY 5-11-04 280
Lowest weight 174
Highest re-gain 238
erny 3-23-09 (120 common channel
low post revision 190
Current Weight 204
Height 5'6"
GOAL 154 Normal BMI
srooker
on 1/27/10 9:21 pm - Port Byron , NY
on 1/27/10 9:21 pm - Port Byron , NY
Hi Cindy,
I hate to be the bearer of bad news, but you'll probably have to appeal (multiple times) and that could take up to a year.
Now for some good news .... if you've had the band 2 yrs and still have a BMI of 35/40 with comorbidities, such as Hypertension or diabetes that didnt resolve with the first surgery, then you'll have some grounds to fight on.
Hang in there and keep fighting ..... it took my wife almost a year of appeals, but she finally won ... so don't give up.
Best of Luck,
Scott
I hate to be the bearer of bad news, but you'll probably have to appeal (multiple times) and that could take up to a year.
Now for some good news .... if you've had the band 2 yrs and still have a BMI of 35/40 with comorbidities, such as Hypertension or diabetes that didnt resolve with the first surgery, then you'll have some grounds to fight on.
Hang in there and keep fighting ..... it took my wife almost a year of appeals, but she finally won ... so don't give up.
Best of Luck,
Scott
Blue Cross of IL is very similar to Blue Cross of Alabama from what I've read. Both of them are notorious for stalling, even when they know they will eventually have to pay up. I was denied the first time for "low BMI and because my Barrett's lesions biopsy came back negative for cancer". They took the legal amount of time to the day that they were allowed for their response.
My surgeon called the medical director of Blue Cross to explain that I need the revision, and he was able to get approval for me.
Not sure the exact time that it took for approval, but you can check the dates on my blog. From the first day of going to see the surgeon to the day of my surgery will be around eight months. I had a three month wait after approval because I am a revision and my surgeon only does revisions on Monday's. He's a busy doctor, so I was scheduled three months out.
I believe that if you have the right surgeon behind you to help you fight, and if you stay with it, you can get approval. Not sure how long it will take, though. I had the same Blue Cross policy for my first surgery ten years ago, and I was denied twice before approval. It took a year to get my surgery. Just trying to give you some time frames. Best of luck.
My surgeon called the medical director of Blue Cross to explain that I need the revision, and he was able to get approval for me.
Not sure the exact time that it took for approval, but you can check the dates on my blog. From the first day of going to see the surgeon to the day of my surgery will be around eight months. I had a three month wait after approval because I am a revision and my surgeon only does revisions on Monday's. He's a busy doctor, so I was scheduled three months out.
I believe that if you have the right surgeon behind you to help you fight, and if you stay with it, you can get approval. Not sure how long it will take, though. I had the same Blue Cross policy for my first surgery ten years ago, and I was denied twice before approval. It took a year to get my surgery. Just trying to give you some time frames. Best of luck.
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