Any advice on Bcbs denials

Hello,

I am doing revision from sleeve-to-sleeve or "re-sleeving" and i have BCBS of TX. My surgeon and his staff submited the request and it was approved, that is all the info I got from my doctor and his staff.

A couple of week's later, I got 2 letters, the one with an older date was rather lengthy but it was a denial. The second letter,with a more recent date stated that the procedure was approved.

I contacted my doctor's nurse and she stated that it was denied, but that after they appealed and did a peer to peer review it was approved. I am not sure if it has to do with how they appealed, or if it has anything to do with my clinical condition as it was presented or just the insurance likes for doctors to beg a little.

Have you talked to your doctors or their staff to see what else can be done?
Wishing you the best!

Javier

Thanks Javier. Hopefully its approved soon.

Just letting you know that I had the Lap Band in 2008 and the doctor repaired my Haital Hernia while was did the LB. In 2009 got revised to the VSG and my Haital Hernia is still causing me problems and the acid reflux is much worse now. I heard that the RNY will not give you Haital Hernias and cause acid reflux. Do your research on that too. Best Wishes to you dear.