Well,
After EVERYTHING I went through, all the procedures, all the stress, it turns out BCBS misquoted my Provider and the treatment of obesity is an exclusion. BCBS told my provider that yes wls was covered, yes the sleeve was covered, and here are the things that need to be done before pre auth (endoscopy, dietitian appointments, upper GI, psyc eval...yada yada yada). :scared0:
I was about a month away from surgery when I was looking through our plan docs for chiropractic information. All of a sudden I was bit in the face with an obesity exclusion! What!!! OMG, I called my provider. She called BCBS and sure enough, excluded. BCBS said don't worry, if it s a misquote it will be covered....
I waited a month for a misquote review only to find out that their denial reason was "A misquote of benefits has been reviewed and denied as there are no claims on file for this provider." Well of COURSE there are no claims...you told my provider it was excluded in the second call! :cursing:
I am having my provider actually do a pre-auth so that I can get a denial letter. Hopefully I can appeal somehow. :001_tt2:
During all of my testing, I found out I have a moderate hiatal hyenia, high blood pressure, and acid reflux. Has anyone had any luck getting approved using these diagnosis codes? My insurance has an exclusion for any treatment of obesity but not the surgery itself (hence the misquote I think.):confused1:
Any help would be appreciated. I am also considering contacting the Insurance Commission regarding the misquote, what do you think?