Peer to peer.... cross post

chinamama
on 3/23/13 3:43 pm - Bend, OR

I have been approved for my lapband removal but denied the VSG from Fed Blue cross. According the the insurence the dr can request a peer to peer review, Anyone done a peer to peer? What is the process????

       

Highest /Consult/Pre-Op/Band Surgery/Lowest Band/ VSG Surgery/Current/Goal

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JoCoAnne
on 3/25/13 11:42 am - NC
I am in a similar situation. I want to go from Band to Roux n y, and the insur co denied. They said my Dr can do a Peer to Peer review. He will contact the Medical Director at my insur co and try to convince him that I need the surgery. If that fails, then they do a formal appeal, and he says I may have to have a couple of tests that weren't originally required in order to prove that I need it. Office says the Peer to Peer will happen within a week. Keeping my fingers crossed. Best of luck to you too !
Sherrie P.
on 3/28/13 11:58 am
RNY on 02/06/13

FYI my peer to peer was a no go but my personal appeal letter worked.  Don't give up - especially with Blue Cross!!!!

Revision Lapband to RNY 2-6-2013   HW: 286  Pre-Op Diet: 277  Surgery Day: 265  Goal: 155  CW: 155

Plastic surgery 8/28/2014: Brachioplasty, mastopexy, & abdominoplasty.

Plastic surgery 1/27/2015: Butt Lift

    

ceedott
on 4/11/13 2:43 am - PA

i have questions i'm in the proccess of trying to get revised from the band to the sleeve when i got the band done in 4/09 i had khpe and was at a totally different job now i have personal choice at my current job  but its still under the independence blue cross umbrella....is anyone familiar  with this insurance and know if they have a once in a lifetime clause?? bc my insurance covers 43774 and 43775..b/c if they have one i want to have my appeal letters and information together so i can begin to fight

my band hasn't been filled for almost 2 yrs i think bc every time i get it filled i have to get it unfilled  i had problem with heartburn,acid refelx, etc then when i was getting fills the dr stated he doesn't think my band is filling properly and my port was bent they always had a hard time filling my band..so they said it must come out i've gained all my weight back i lost

i need help

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