Denial Overturned - Jan. 17th surgery date

[poslisa 0]

Finally got word that BC/BS granted my appeals and my surgery is now scheduled for January 17th. I was originally denied because I did not lose the 5% prior to surgery (was told by surgeon to be careful because my BMI was around 37 and he didn't want me to go too low) and they also said my psych eval stated that I wasn't a good candidate. I lost the 5% and also advised them that the psych eval suggested that I was a GOOD candidate for surgery. It took them almost 30 days to approve it but they did and now I am excited and scared at the same time. I'm hoping that the next 3 wks fly by. Now just have to decide on which lapband to get.

[happygirl65 5]

NICE! Way to go!

[StacyS 2]

Do you live in California? I also have BC/BS PPO for California though and was wondering if I might experience a denial as well...

[Phranp 46]

Do you live in California? I also have BC/BS PPO for California though and was wondering if I might experience a denial as well...

Hi Stacy,

I have BC/BS PPO as well, although here in Cal (I live in L.A.) it is called "Empire BC". I don't know, it's all very confusing. The ONLY problem I had (surgery 6-15-09) was I went through 4 docs before I found one that would accept the low payment that BCBS will allot for the surgery. In one case the surgeon was okay with it but the surgery center refused. And yes, the surgery center was contracted with BCBS, but still they refused because they said that BCBS wouldn't pay them enough. I was soooo angry. My surgery was rescheduled for two weeks later with a "general surgeon" not a WLS surgeon. He's a nice man, competent surgeon, but did not have a lot of information or experience in the aftercare. I have done alright (went from size 26 to size 14/16 so far and still losing), but would have been nice to have had a WLA surgeon.

You might want to check out the BCBS website, I found all the info about qualifying for the surgery and what they expected there.

All the best to you on your journey!

~Fran

[poslisa 0]

Stacy - I was denied because I did not lose the 5% prior to submitting paperwork for approval from BC/BS (NY). I would suggest that you ask for a copy of your BC/BS requirements for bariatric surgery so that you can review them prior to having your paperwork submitted. My BMI was below 40 and I was very concerned about getting denied because of that, so when the denial came I was not surprised but actually pleasantly surprised that it was only because I did not meet their 5% weight loss pre-requirement. Good luck.

[spoiltmom 44]

Congratulations!! Way to go for sticking it out and filing an appeal.

[conservachick 0]

Congratulations!!!

I wish for you all the best!

Get ready for a great ride!!

[amberakamom 13]

YAY! Congrats!