Question:
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?    — dandjon (posted on June 7, 2001)

June 7, 2001
My case was never approved or denied but it has gone in for medical review with the med director. Now it has to go before the appeals board. With my policy, I can appeal 3x. Just like you, I have provided everything they have requested and I meet the criteria to be approved but they are dragging their feet. My boss (who is a lawyer)even wrote a letter of support. If you are denied on all three levels you can attack them legally, which my boss said she would do for me. HOwever, she seems to think that each level keeps tossing it to someone else so they can be the one who is "spending the insurance company's money". From what I understand, hope and pray, is that we should hopefully get approved this go around. I completely understand your frustration and due to their dumping onto someone else and saying each time they have 30 days to review, I don't think I'm going to make my surgery date for June 14.
   — [Anonymous]

June 23, 2003
HIRE WALTER LINDSTROM, I am about to do that. I fought this far to level III and I still was denied. I have Group health options. They toss and add more stuff to your information that you have sent. I'm fighting for Asthma, I have severe asthma. I don't know how they find these people that have or maybe will never be in our shoes and make their decisions based on (I think flipping a coin). Walther has been where alot of us are in now and he knows what it feels like and that is why I am taking a chance on him. Keep fignting. I am.
   — Annette W.