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Insurance Denied Surgery

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cbd

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Hi...I am so disappointed today. My insurance (BCBS of IL) denied my surgery request. They said that the reason was that my hypertension and hi cholesteral were missing the documentation that those conditions have been treated with agressive medical management and still were not stable.

I am waiting for a call from the insurance coordinator at the surgeons office to see if we can appeal.

 

I have been preparing for this both mentally and physically since May and now this....I did not have a plan B.

:( Somehow I knew this was too good to be true.

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My insurance wouldn't pay for my surgery either even though I had high blood pressure, borderline diabetes, and was almost 300 pounds. I decided to get online and apply for CareCredit which is high interest but I was approved and I had my surgery and paid 18,000 for it. I now make payments but I had no other choice. I knew I had to have this surgery and I borrowed the money. I'm so glad I did now. I am so much better and so much happier. Hope things turn out for you!! Oh and now I've lost 78 pounds in 5 months and am down to 218. :)

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do you have PPO or H.M.O.? I have bcbsil as well, H.M.O. and I'm wondering what the process is... I got a referral to a surgeon approved, IDK if I have to still get surgery approved beyond that?

I used to work for bcbsil PPO for individual plans. I don't think I understand the reason you were denied. Did you get a letter? What did it say? Have you called them?

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Start a diet to lower your bp and cholestrol and then when you appeal they will see you made progress on your own and lost some weight and lowered your bp and cholestrol. It wont be easy but fight for what you want honey. Good luck

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BCBS wants to see it in documentation that my bp and cholesteral are not under control after exhausting aggressive medical interventions. I am not sure that I can provide that documentation. I have been on medication for bp for 12 years and it is in a good range now.

I have a PPO and it approved my surgeon appointment. I have gone thru all the steps required just prior to surgery (informational meeting, bod pod, three month supervised diet, surgeon visit and psych appoint). All was submitted to the insurance and I had called to check on the status of the pre authorization request and that is when the insurance told me that they had mailed out a denial letter the day before and why. I called my doctor and she wants me to come into the office, have some labs drawn and work on the documentation.

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