What? Why So Confusing

[Heyher 581]

So I thought we sent the request for external review with the IRO. Well UHC denied my 2nd level appeal. So have to submit AGAIN to get it to the IRO. What the crap????

Sorry, insurance is sooooo screwy some times.

[AStephenson 159]

I never even made it that far. My insurance (Anthem BCBS of Ohio) policy had an exclusion for anything weightloss. I got a very flat and resounding "NO". In a way I think it was a blessing in disguise as I feel I saved myself lots of time and headaches by deciding to pay for it myself. I am scheduled in February with Dr. Ariel Ortiz at Obesity Control Center in Tijuana, Mexico. Don't give up..even if insurance refuses again there are other options!

[Heyher 581]

So I sent in the request for external review this morning. 58 pages of diagnosis, medical studies, tests, letters, ect. Also wrote a three page letter about why this surgery is needed. Doc office should be sending in their portion today too. Hope they see the benefits of surgery for me.

[barrbdoll 287]

I never even made it that far. My insurance (Anthem BCBS of Ohio) policy had an exclusion for anything weightloss. I got a very flat and resounding "NO". In a way I think it was a blessing in disguise as I feel I saved myself lots of time and headaches by deciding to pay for it myself. I am scheduled in February with Dr. Ariel Ortiz at Obesity Control Center in Tijuana, Mexico. Don't give up..even if insurance refuses again there are other options!

Dr. Ariel Ortiz is amazing!! That man has changed my life and I am a true advocate! I had my surgery April 16th and I am down 113 lbs so far!! Truly the best decision I have ever made!!!

Good Luck!

[melissamhe 0]

I have BC/BS of Alabama & was denied immediately ( after the required 6 mos nutrition visits, psych eval & so on) because bmi was not documented @ 40 for 3 yrs, & the nutrition visits not signed by PMD . BMI 37 to 38 for 10 yrs... No where in the policy did it say any of this !

Have decided to pay out of pocket using other resources. It is worth it at this point. There was no way to appeal.

[denise60 5]

Oh no melissa im also using bcbs of alabama...i hope I dont have this issue also....im sorry your having problems

[Heyher 581]

Insurance called to let me know my external appeal has been sent and I will know the final decision in 30 days.