Premera BCBS Appeal--Change of Surgeons

[FitatFifty 11]

Greetings all-

I submitted my first level appeal with Premera BCBS recently. My appeal adventure resulted in a change of surgeons for me. My initial surgeon, who I was referred to and is well-known in our locale for skills, according to the office staff, would not participate in my appeal. This included an unwillingness to read my letter to simply ensure I was not overstating conclusions found in medical journal articles. I found this attitude unsettling...was I just $$$ in the door--what about after my surgery??

Long story short, with a little research, I located another surgeon closer to my home--and just as highly skilled. Without revealing my story to his office staff, I asked the staff what support if any, they provided for insurance appeals, and she reeled of a list of assitance, including a letter from the surgeon. Since you've been patient and read to the end of my story, the moral of the story is that it pays to switch doctors. My new surgeon wrote a killer letter on the medical necessity of the sleeve for me, I am so much happier dealing with this office, and my husband prefers the new surgeon to the old.:scared0: And for those of you just getting started...be sure to ask what type of assistance the doctor and her or his staff will provide should you need to appeal.

Stay tuned, I'll let you know how this turns out! Finally, I'd like to thank all of you who have generously posted thier appeal letters on this site. If I am successful with mine, I too will post it. Maybe you'll recognize a little of yourself in my letter!!

To our good health--

Fit

Edited August 18, 2010 by FitatFifty
gender neutrality

[mila1013 0]

glad you got rid of that first surgeon, would not have been there for you....good luck with the appeal

[FitatFifty 11]

Thanks Mila--

I'm glad I moved on too! I'm trying not get my hopes up, but Premera has not yet issued a denial letter (the last one was quicker than lightening!!), so I know they are at least reviewing my case.

Fit

[Carrie 4]

Please do keep us posted, with you being in Bellevue and on Premera we maybe dealing with the same branch of Premera. They denied me at first, I submitted my appeal and have gotten a letter stating they have gotten my notice of appeal but I haven't heard anything from them. They are covering my lap band removal but I am paying out of pocket for my sleeve expenses (around 8K) and hope for reimbursement if the appeal goes through post-operatively.

[FitatFifty 11]

Carrie

I'll keep you posted on how my appeal proceeds. Both my doctor and I wrote persuasive letters based on sound research--especially his! Hopefully, not only Premera, but the other insurers out there will see the light soon.

Cheers!

Fit

[mila1013 0]

fat chance of that (LOL) insurance days are numbers, we know that, they know that, but they will deny all they can before that. will make no difference what you send them, you can send them RNY will cause your children to become baboons, (ok this is not true i am making a point here) you can send them band will cause you to lose your arms and legs to grown more appendiges (ok this is not true i am making a point) they are goign to deny you just because it is a sleeve, keep appealing till you get it overturned. heck most people dont appeal so they have nothign to lose.....keep working on it everyone, don't let insurance co tell us morbid obesity is not a disease and don't need to be treated

MIla