insurance denial

[banding12 1]

Can anyone help? All my info was submitted to my insurance on Nov.4,2010, then the following week we received a letter stating that they wanted results of my sleep study, the results and a letter from my GP stating that I have high blood pressure, sleep apnea, 3 month doctor followed weight loss and medical necessity was resubmitted on Nov. 18,2010. Now, I called the insurance company to make sure they received the fax and that it was sent to the correct dept. cause I truly believe they "lose or misplace" your paperwork on purpose, and the person I spoke to indicated that she personally sent it to the review dept.. The following morning I called just to check the status and some twit tells me I MET all the medical requirements and have been APPROVED, so I immediately contacted my doctor's office to tell them the GOOD news, they contacted the insurance company and was told to call back this week before thanksgiving to get the approval code. Well imagine my surprise when I was contacted by my doctor's office stating the insurance company informed them this morning that I was DENIED!!!! When I called to find out they told me it looks like I have 2 different folders and maybe they didn't have all my info on the first look, so I asked a few more questions, then she tells me it looks like they don't have proof of 2 co-morbities, when she just told me she has the letter my doctor sent her and the medical transcript from my sleep study. I AM SO CONFUSED,and to top it off, I have been on my pre-op diet since Friday and my surgery is scheduled for Dec.6th. If any one has any advise or help please respond. Thanks in advance.

[happygirl65 5]

OMG! That sucks! Keep calling them, they have to sort it out, demand a supervisor or a nurse advocate...you will get it straight. I hear BCBS is pretty fast...hopefully you will have better results once the holiday weekend is passed and they can concentrate on business again.

Good luck!

[ElfiePoo 109]

I have BCBS of Michigan and it was a snap. I think a lot depends on how organized the doctor's office is in documentation. Barix clinic does only WLS so they no exactly how to deal with the insurance company as far as filling out forms, etc.

You may have to delay your surgery but it sounds like you were denied due to incomplete paperwork. So I'd be patient and just keep pushing forward.

.

[banding12 1]

Update : the denial letter sent to my surgeon states that they have no info on my co morbidities and proof of my doctor followed diet. In the letter my GP sent them it states my high blood pressure plus they have the progress notes stating I'm on medication for it and second they have the sleep study interpretation report that states I have sleep apnea. I am so lucky to have the insurance rep at my doctor's office, she told me today that she deals with this all the time and she will get it straight, and my GP is correcting the 1 progress note that he forgot to included the diet and exercise part. I am stressed out by all this, I have gone through the process of telling my family ( some do not approve) and I just have to pray and put this in God's hands. Hopefully my prayers will be answered. Thanks for the posts, sometimes you just need to be reassured that the end result is worth all the trials and tribulations you have to go through. Will update soon.