Denied Now What?

[yellowbox 55]

I received a letter from BCBC MS denned. What do I do now.

[NewAshes 232]

Call and find out why. Fix it and or appeal it.

[SqueakyWheel&Ethyl 160]

Call the ins. co. Ask for the Medical Director's office responsible for approving procedures.

It's possible they NEVER EVER cover this under any circumstances.

Or, they cover it based on specific criteria. Find out which one applies here.

Do they cover if the patient is over 100lbs overweight? Or if they have Diabetes and other conditions?

They won't volunteer this info. You have to press them for it.

If there are SOME cases they would approve (like listed above), then your next Quest is to see if you qualify based on their criteria.

If you do, then you need to request a list of EVERYTHING expected to be done to garner approval. Such as:

Nutritional Counseling

Psychiatric Evaluation

Lab work

Keep a 6 month food journal

Etc.

Keep a journal including every phone call or email, etc. WHO said WHAT and date/time.

Check off each of their criteria as you accomplish it.

Get on a first-name basis with whoever your point of contact is with your insurance company's Medical Director's office. Check in with them regularly and ask, 'what else will you need from me?'

If they absolutely do not cover under any circumstance, then it's a closed subject. But, they many times WILL cover under certain criteria, BUT they don't want their customers to know it. That's why you must press for the info.

Good luck!

[yellowbox 55]

Thanks I get right on it tomorrow. I was shocked when I open the envelope, not feeling good right now. Going to sleep again.

[NewAshes 232]

Good luck