BCBSIL revision insurance issues

I am trying to be patient, I think I've been REALLY patient. It has been over 2 years since I have been dealing with my slipped/prolapsed band issues. Last year, BCBS IL denied my revision stating I needed to do the 6 month weightloss plan again. Okay, so I did that, amongst other new things. I had to switch hospitals/surgeons for the second time because that hospital cancelled their revision program. Now, hoping/thinking everything will go better now and just found out the BCBSIL denied my revision again, but lists no reason and just states to look at prior denial records. Errrr!!! So apparently now it is under verbal appeal...? I have a call into my surgeon's office for more information, so we will see. They are denying both the removal of my band and the revision to VSG. I don't understand how they can not follow through with aftercare on something they authorized me to have 4 years ago and deny the removal...I guess they are just wanting to wait until I have tons of damage and must have emergency surgery to remove? 

So frustrating and needed to vent!! Anyone experience this? I don't know how the appeal process works and what happens from there.

Thanks again.
Amy

Sounds like there is something missing with the info they are getting from your doc. If it has slipped and prolapsed it is a medical emergency to get it fixed or out. Are they sending in that info or just asking for an OK to revise for no reason. The only reason to deny it would be if they do not cover bariatric surgery at all. I would contact both the doc and the ins. co and find out what the problem is and if you are doing something wrong and how to go about getting this approved. Good luck!

I feel your frustration - I am trying to get my bypass approved through BCBSIL and am beside myself!  I need the surgery because I have severe acid reflux - on top of that I have a chronic lung disease and I am aspirating so the longer I wait the worse my lungs are getting...

My inital request was denied because they determined the surgery was not medically necessary - really???  Then they upheld the decision with my appeal.

My surgeons office and I were both told that we had to wait until we received our "letter" from the medical reviews before we could request the peer review.

I'm upset because I actually know people who intentionally gained weight to up their BMI so they could have this surgery - and they were approved righ out of the gate.

So...I sit, unable to do anything, hoping a decision is made hoping I can make it on my disability pay until the surgery is approved and I can hopefully get back to work and on with my life!

GGGGGRRRRRRR!!!!!

Good luck to you Chris! This whole process can be very frustrating! Hope things improve for you soon!

Amy

Same to to you.  I did learn that some VERY important test results did not get submitted with my original request - hopefully after these go in I will be approved during with a peer review. 

I just hate waiting!

If they approved getting the band and you have these medical issues, I can't see them dening getting it out.  Now for getting another surgery, I am in the same boat.  They don't want to let me get the sleeve.

That was my point too...but they sure denied it 2x to remove the band. But I just posted a new post yesterday that I got my approval after appeals!! Yay! Remove band and revision.

Good luck on fighting your insurance company...we are sure at their mercy! And it is SO difficult to be patient and hope for the best!

Amy

Amy that is great to hear!  Good Luck with your revision!

Congratulations!  My Peer to Peer was yesterday and I should know something by Tuesday of next week.

We have a lot of information on our site about both revisions and the appeal process which may help you out a great deal.  I feel your pain since we fight against BCBS IL quite frequently!

For revision info:  wlsappeals.com/common-bariatric-denials/denials-revisions-an d-conversions/
Regarding appeals:  wlsappeals.com/you-must-be-prepared-to-fight-your-insurance- denial/what-is-an-insurance-appeal/

Good luck!