grievance after being denied from BCBS

[cat lady 10]

Has anyone after being denied had any success with a grievance against BCBS. I really want to do the surgery but they have denied me b'cause my blood pressure is under control with 2 meds.

[~*~Rachel~*~ 2]

I have BCBS as well if your BMI has been over i think 45 and you have two comorbitities then you should be approved blood pressure controlled by meds or not... if your BMI has not been over the allowed amount for three years then it will be harder.... It is a lot of work to get qualified but it might help if you get a letter from a doctor either if you have back problems or heart conditions or someone saying arthritis in your knees... I have not been approved yet one more visit on the 30th for my six months but they basically said that i would be approved since my BMI has been greater then 50 for the past three years other conditions or not

[StacyS 2]

I have BC/BS and have just started the process. What is your BMI?? I have read the benefits packet in detail and it clearly states that if you are over 40 BMI, you qualify w/out having to have co-morbities....

[banding12 1]

I also have BCBS and after being told that my doctor's office had not submitted all the required paperwork and then being told I was denied because of lack of info on comorbidities and then appealing and finally being approved..... it is all worth it in the end. Call your insurance company everyday and sometimes twice a day, make sure you write down names of who you talk to and get specifics on what they want. Through this whole process I learned that they don't really look at what is in front of them and different people will give you different answers. If you need any help or more info just message me...Best of Luck

[cat lady 10]

I also have BCBS and after being told that my doctor's office had not submitted all the required paperwork and then being told I was denied because of lack of info on comorbidities and then appealing and finally being approved..... it is all worth it in the end. Call your insurance company everyday and sometimes twice a day, make sure you write down names of who you talk to and get specifics on what they want. Through this whole process I learned that they don't really look at what is in front of them and different people will give you different answers. If you need any help or more info just message me...Best of Luck

[cat lady 10]

Hi all: thanks for your support with my appeal to BCBS. I took some time and put together an extensive appeal with letters from my Drs stating that I have HBP for 20 years which is not always under control, back pain, knee pain, etc. They finally approved me after a Level 2 appeal. I'm happy about this but now scared at the thought of getting banded.......am I insane. Its been 1 1/2 years since I began this process and really kind of thought it wasn't going to happen. Now I must get my head back in the game and get prepared to do this. I'm seeing the surgeon again on tuesday.....since I have not spoken to him in over a year. I have new questions now that this is a reality. thanks again for your support CAT Lady

[AlonCreil 0]

Hope you are in good health

_______________________________________

Navy NCIS

Entourage

[Beachbunny 5]

Bcbs was very easy for approval for me as long as i had a bmi over 40. Make sure your Dr puts all the paper work in and i wrote a detailed 5 page letter of all my attempts over the years with weight loss. I was approved in 3 days.

[PhatKat1127 55]

So I had my lapband on 12/7/12 with Anthem BCBS. I had no trouble getting approved in 2 weeks. Then after one year of constant vomiting fills and unfills. I was only able to get 4 cc total into my 14cc band. I started to have Migraines, panic attacks an finally seizures. I was never diagnosed with epilepsy. I told my surgeon every month that I was having trouble an NO substantial weight loss Every time I went into office he paid no addy entomb to my concerns! Finally (at my 1 yr Mark )he completely removed all Fluid from my band and stated clearly the band was causing more harm than help and I was suffering from Band intolerance. He said he would do what ever it took to seek the sleeve for me as it was medically necessary to have the band removed immediately! I got a call from my health advocate stating I was denied a conversion. Although the Removal was Approved. I asks the advocate what was in the letter. She stated my surgeon mad no mention of my issues.. No mention of intolerance! No mention of my seizures or the fact that I was on 200 mg of antiConvulsion meds along with Prozac and Xanax. Basically I was denied since My surgeon didn't supply enough info. WTH!!! I was livid! So I got a new surgeon since my primary failed me he lied! He also said it was going to be difficult that I was the 1st to have this issue or the band removed from his office (another lie) My new surgeon confirmed by band could not be salvaged. Also through the barium swallow discovered the band was too high and even if repaired would slip right back up due to an indention That was already created. My new surgeon stated he had no respect for my previous surgeon or his techniques as a matter of fact he had already removed 25 lap bands from (MY surgeons office) in the past year alone! So my new surgeon is attempting to help me file a Grievance and hopefully bcbs will reconsider my conversion to the sleeve!

Edited March 4, 2014 by PhatKat1127

[30SOMETHING 16]

Good luck on getting the denial reversed. I also have lap band failure. My port dislocated and my band slipped. Right now I can't eat anything nor can I get an unfill.

[PhatKat1127 55]

I am so sorry for what you are going through! Out of the 7 yrs of research I had done on this, I never heard LAP BAND INTOLERANCE! I am left with 12 Scars no weight loss and even worse health conditions. But as I read about it I am seeing more and more people that are going through this.

[PhatKat1127 55]

Tonight I can't sleep!! As I research all avenues I really hope my New surgeon who removed my band (due to intolerance) has supported enough in the greivance process gets a BIG PHAT YES!

I didn't do anything to deserve this! I followed the rules but apparently intolerance was my obstical... I pray to God I get approved for the conversion to the sleeve!