Insurance denied my Revision - I am so upset

katibaby
on 11/15/15 7:44 pm

I just found out that my Insurance denied my RNY revision due to me not having enough doctors visits from 2007 to current. I lost my Insurance a while back and couldn['t afford to see a Dr. Now what? Am I done? Is it over?I feel lost now as I was so looking forward to the surgery, Any one have any advuce? I am guessing I am going to file an appeal but feel hopeless...

 

I have Blue Cross Blue Shield of Minnesota BTW.

katibaby
on 11/15/15 8:03 pm

Anyone??

cmcelfish
on 11/15/15 8:05 pm

call up tell them you want to file an appeal. They will probable have 30 dayscto answer you appeal keep appealing. Keep goofpd notes of anyone you sleek to what was said. Your state should have an insurance commissioner call them . Serious ongoining medical problems sometimes go to the top of the list. They may push for you because you had lost insurance. Be very nice to everyone but let it known you don't want to have to get a lawyer involved. You have to be willing to fight no one elsec will

 

 

katibaby
on 11/16/15 8:25 am

I just called my clinic and they said I don't need to file an appeal yet that I just need to submit additional paperwork showing how much weight I lost. I didn't have health Insurance for some time and only visits I made were to the ER for random sicknesses. I am not sure what I should do now...

A. Robinson
on 11/16/15 2:53 pm - Columbia, TN
VSG on 04/29/13

That same thing happened to me. I lost my insurance 8 mths after my surgery. I had an appt on the 11th and missed it! I was crushed. I didn't think about crossing over into another time zone and missed my appt by an hour. I rescheduled and they made it for Jan 7th. Ugh. I will keep you updated. Good luck. I know exactly how you feel.

    

    
A. Robinson
on 11/16/15 2:54 pm - Columbia, TN
VSG on 04/29/13

To clarify...I had the appt with the revision surgeon....2 hrs and 45 min away.

    

    
(deactivated member)
on 11/16/15 3:14 pm

Certainly couldn't hurt to try and find out how many Drs appts they expect you to have and now you have ins to go to the Dr frequently even as you qait for your appeal results.

MaryFulps
on 11/22/15 2:26 pm

Blue Cross is usually pretty easy to work with (my experience). I agree - call them & see what they want.  It may be as simple as a letter from your Doctor showing "medical necessity."  ANY other health issues you may have - high blood pressure, asthma, arthritis - can be used as factors to prove that this surgery is necessary.  PLEASE don't give up - sometimes you have to turn into a bulldog to get what you need.

You are your own advocate.  Keep a notebook with dates, times, who you talked to & take lots of notes.  But keep on it - you will win!

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