Well guys, I am afraid I have no good news.
Anthem BC/BS denied my appeal level 1 as “investigational”. Surprise, surprise, right?
Even after I have all my papers, letters from my doctors that stated that I need to take NSAID and my surgeon office provide medical researches on my behalf, no dice.
Now I am fighting with them to let me bypass Appeal level 2 and go direct to Independent external review appeal witch I believe would be my best bet.
I feel that Appeal level 2 will provide the same results since Anthem is not looking at your medical problems they are just hiding behind the policy.
As I read this panel have three doctors independent of insurance panel that they look @ the medical necessity only. If they rule in your favor, the insurance has to cover your surgery, no questions ask.
The whole thing It’s depressing and frustrating especially when all other major insurance companies already updated their policy to include sleeve.
But I am still not giving up.