Denied by BCBSI for Lap Band Surgery And Devastated!

[loretta\ Baconton Georgia 10]

So I was denied. .I have my comobidities. I have the BMI. They denied me based on documentation.. They said that I do not have the behavioral modifications documented for my 6 months non surgical weight lost. I wernt to the Simply U Med Spa in Albany Ga.. They do not provide per visit documentation like a dr does.. This is a kicker. I offered my own journal notes. I sent them and will also send my pharmacy records where I used appetite suppressants.

Also do not have documentation that I have tried extensive measures to treat my comobididies. I have a CPAP for sleep apnea, I have oestoarthritis. I have had two neck surgeries, I have had root deadners, and epiderals and still take pain meds every day.. I need help..... What do I do now???

[LarraineM 6]

Just take a DEEP breath, and follow all the steps they tell you to. Its not uncommon for them to require 6 months of documented weigthloss attempts. Sometimes I really think they are attempting to wear your resolve,and hope you'll get frustrated and just walk away MAD..................don't give it to them presist

[Shellyac 22]

I would go back to the med spa and see if they they would be willing to fill out some information after the fact. I think if they at least have your weight at each visit, you might be ok. I have a template that a surgeon's office gave to me to give to my doctor after the 6 months and I think it was good enough. I would be happy to send you a copy if you provide an email address. Also if they can't provide per visit info, see if they would be willing to provide a letter detailing what you did with them for the 6 months

You could also try to file an appeal, I think if you at least have some proof like payment records to the spa that will probably help.

Worse case if you might have to go through the 6 months again, I know that it seems like a long time to wait but if that is all that stands between you and the surgery then it will be well worth the time.

[xavier 153]

Both suggestions are right on...they want you to give up! Please dont! From where I am sitting (in maintenance and more than two years since banding) six months will seem like nothing. When you are in the middle of it though, its agony....but if you are at a normal weight and just coasting a long two years from now that six months wont matter...hang in there!

[loretta\ Baconton Georgia 10]

I did the six months diet. The problem is that they want it to show behavioral modofications and counseling for each visit and I do not have that..We discussed it at each visit but it is just not documented like they want it to. Med Spa will not give me any thing else. I turned in my personal journal and we will see what they say about that. At this point, I am just MAD. No, I wil not give up or give in!! If I have redo it again I will just be so sad.. I want to get this chapter of my life started. My email is hlorettawilliams@gmail.com... I may need the form if I have to start back over AGAIN>

[Dawn200321 146]

Wow I am so sorry you are going through this. I really will pray that you do not have to start over again but if you do just remember that it will be well worth it the long run. Just like xavier said..whats another 6 months when were talking about a lifetime change!

[sandy1341 1]

I would go to your Med Spa and have them to provide you with documentation, also go to your PCP to provide health documentation it may take a few months but don't give up! It will happen. My surgeon provided me with forms to be filled out by my doctor which made it easier and I kept for myself a copy of everything because sometimes my PCP doctor would forget to provide my surgeon paperwork on time (very important). Most Insurances require 6 months documentation without skipping a month or you would have to start over. Best of luck

[horsegirl315 114]

Does your potential surgeon have a team of people you could work with? My surgeon has a team of people, like nutritionist, that I met with 3 times once a month, to satisfy my BCBSRI requirements. All my appts were made by my surgeons office, all within the network of people they work with--nutritionist, psychologist, etc. I think if you can ask your surgeons office to refer you to the people they usually work with, you may be better off. They probably know better than anyone exactly what needs to be provided to insurance, and how it should be presented. Good luck!

[GermaineF 25]

i too was denied by BCBSI not once but TWICE!!! My Dr submitted all my paperwork Oct 19th and at the end of the month I got my 1st denial. I was pissed!!! I didn't give up even when it seemed as though the staff at my drs office did. I took it upon myself to have sleep apnea test done and had them fax that paperwork in and called BCBS EVERY SINGLE DAY!! Yesterday they sent approval letter to my dr, today I went in to sign consent and i'm scheduled for surgery on Dec 16th. yep next Friday...what ever you do, DON'T GIVE UP!!! and don't rely on someone else to get necessary paperwork for you. Do it yourself, make the calls yourself and document who you spoke to..Good luck to you dear...