Blue Cross of California

[Grant 0]

Hi,

I just received my letters declining benefits for the band. I wondered if anyone has had any luck appealing to Blue Cross. Also is there any point in having an attorney handle the appeal. I contacted Obesitylaw.com which came highly recomended, but they will not work on cases after the surgery is done.

Thanks for your ideas

[GeezerSue 7]

What was the basis of the denial (if you don't mind my asking)?

[Grant 0]

Hi Geezersue,

BC said that the procedure is investigational or experimental. I requested the appeal form.

[marsha 0]

I think you probably have a good chance of overturning the denial. The lapband is not experimental! It is FDA Approved. If you want a real opinion, Walter Lindstrom (obesity insurance attorney) would probably give you a better idea! www.obesitylaw.com.

Just a thought,

Marsha

Please dont give up!!!

[Grant 0]

Thanks Marsha, I did check with the attorney you suggested but they are no longer working with post surgical claims

[cadydid 0]

Wow,

I know I didn't want to fight my insurance due to the same reason and just paid Dr. McKeen. But having worked in the medical profession, first I would call Chris is his office for her advice. Get a letter from Dr. McKeen, your cardiologist and your Primary Care MD. Send those with your own letter to Blue Cross.

You could start by (excuse me) kissing ass. Call and be very polite, and act very innocent. Ask to talk to someone about the denial. Explain you had no idea that when this procedure was ordered by your MD that it was not covered and what do you need to do to get this approved. That how could you have been admitted and the surgery done without it being approved? Again, act innocent and dumbfounded. 99% of the time if you are just as sweet as sugar (which you are), don't get upset or bash them, you will get someone who will work with you the whole way through (be sure to throw on the thanks and I understand it is not YOUR fault). If it turns out that it does get approved make sure you get her supervisor's name and address and send a letter of appraisal, also I usually sent flowers to the person who really helped (even though I was the one in the doctor's office trying to get things covered). Blue Cross of CA actually has a good reputation of working with patients.

Let me know if you have any other questions.

Carol

[Grant 0]

Thanks for the advice. I already knew that they would decline it. I tried to get them to approve it before I had the surgery. Now it will be an interesting challenge to see if I can get them to see the error of their ways.

[TraciLJ 0]

Grant:

Maybe try contacting someone at INAMED. I know they're helping my doctor's office out with requests that are being denied on that basis.

Good luck!

[Grant 0]

Thanks Traci,

That was probably too obvious for me. I'll check it out.

Grant