Anyone With Highmark Bcbs?!

[Texas89 8]

Hi I only need my last visit then my file will be submitted?!just want know has anyone got denied with the insurance i have now?! Highmark bcbs pittsburgh...

[tumblersmom 60]

Hi I only need my last visit then my file will be submitted?!just want know has anyone got denied with the insurance i have now?! Highmark bcbs pittsburgh...

Hello!! Yes I was but my bmi was 42. If your bmi is 50 or over you will be fine. If not prepare to fight for it. But it will be worth it bcuz my surgery is this Tuesday, June 26th!!

[Texas89 8]

Congrats...could you pls tell me what u did to get approved?! I live in dallas tx btw...or could u give me any hints...pls i dont want the gastric bypass...why reroute my insides when i could just get a partial of my stomach removed ...

[tumblersmom 60]

I did an expedited appeal which you have to get a letter from your doctor to send with it to get a response in 3 days. Of course they denied that. Then I had to do an external appeal with an IRO (Independant Review Organization) and they approved it so now Highmark has to pay for surgery. If you have to do an appeal just make sure you put a lot of medical facts in your letter & state your case as to why the vsg is better for you than rny or the band.

[Texas89 8]

Oh god...so i have to write a letter saying why i should get the sleeve...does it have to be prefect?! Like as in proof read and correct spelling, punctuation marks and the whole writing thing with foot notes and printed out on white paper?!..or just note book paper and a pen..do u have any websited where i could get ideas from nd what IRO the one in texas or does ot matter what state?!

[Texas89 8]

*perfect

[Texas89 8]

Okay now i get it....what ur sorta talking about ...i read the form(IRO)...after my first denial ill then send my paper wrk to the IRO... I was so clueless becuz ive never dealt with insurance or had any surgery done what so ever...im not gonna worry so much about it...i have faith

[tumblersmom 60]

Yeah I had no clue what I was doing either. Let me know if u have anymore questions.

[Texas89 8]

I have to go with the bypass becuz my ins coord said its the ins policy,not only tht but i wasted my tyme there...The surgeon tht was goin to do my surgery doesnt do bypass...if it wasnt for this forum and some research i would still be goin with no worries...thank god i found out..

[Texas89 8]

I found another surgeon who is going to do what he can to get me approved for the sleeve...i wanted to ask you did u do the supervised excerise for 6months...?! Or just the nutrition diet thingy?!