I have been denied after first letter because they say the procedure is malabsorptive
BCBS of Il denied my first letter stating "We have reviewed the information submitted and determined no benefits are available for Gastric Restrictive Procedure (CPT 43847). The medical effciency of Malabsorptive procedures as compared to restrictive procedures has not been established through appropriate randomized clinical trials and is not a covered benefit." I had been told earlier that the roux en y gastric bypass is covered as long as it was medicall necessary and if the medical necessity letter was sent to them by my PCP. I plan to appeal, but I thought the roux en y was restrictive and malabsorptive... Has anyone else gone through this? Any advice?
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