insurance denial from horizon bc bs

[m_kuiphoff 1]

Hi just recieved a denial letter for lap band because of a wrong psych evaluation? I went to the Dr. my surgeons office uses? Is this another ploy by the insurance to deny my procedure? Just wondering if anybody else ran into this problem.

[EvaristoK 0]

Call your insurance co and ask for a supervisor and ask what type of evaluation did you have? What type of evaluation are they (Horizon)saying you had at the phych Dr? Do you have a copy of the letter that the psych Dr submitted to your insurance co and did you read it yourself to see what it detailed? Did you get a letter of medical necessity from your primary care physician as well? I have Horizon BCBS of NJ PPO (I do NOT need referrals) but I needed a letter from my primary care, because the Bariatric Dr who performed my surgery told me to obtain medical necessity letter as well.

Originally, my insurance co tried to deny it by saying I was missing the psych evaluation letter, but I guess the Bariatric Dr's office called my insurance co and straightened it, because the next day it was approved. Horizon had the letter all along, but at first they tried to say they didn't have it.

[m_kuiphoff 1]

Thank you I've been trying since Dec. 2014. This is really turning into a project.

[m_kuiphoff 1]

Well it's finally happened! I got approved! I'm so happy! Getting my details tomorrow. So excited.