Has anyone had their approval request sent to the final level of Medical Review?
Some advice would be very welcomed round about now, because I'm so very frustrated. My initial request to BCBS for wls was denied, even though the contract explictly states that surgical procedure for morbid obesity is covered. They needed a letter from my PCP about medically supervised diets tried, which they got. Today I got a call from the ins co saying that the letter received is exactly what they requested, but the R.N. at level 2 of med rev couldn't make a decision so the request for approval is being taken to level 3. For the life of me, I don't understand why a decision couldn't be reached if they got all the info needed. It just seems to me that nothing good can come of this and that I will get a final denial. If I am denied at this level, there's no recourse. My BMI is over 50 and I have many life-threatening comorbs including sleep apnea which I have just been advised that I'll need a CPAP for. HAS ANYONE BEEN APPROVED BY MEDICAL REVIEW LEVEL 3? What do I do at this point?
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