Anthem BCBS Appeal

[SusieT 43]

I did not have sleep apnea... yet. Had a study done about 10 years ago that was "inconclusive". I was not required to attend NUT classes, but our Bariatric Care Center offers free twice-monthly support group meetings with the staff Nutritionist and monthly info mtgs with the surgeon. I voluntarily attended these for almost a year, just to learn as much as I could. At the end of the 6 mo dr-supervised wt loss requirement, BCBS issued a "certification" that was valid for 13 months.

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[SusieT 43]

Typing in jiggly car.... It was for 12, not 13 mo, Had my surgery 4 mo after getting certified. Timing was my choice.

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[bia1nca1 38]

Okay, thanks for the info, I hope I get my certification soon

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[iagree2shine 52]

I'm going through the same thing with BCBSIL, I'm in the 30 day waiting period too. They don't want to cover a revision due to severe GERD or my hernia repair.

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[iagree2shine 52]

@@middlebeaver what did you put to. Finally have them approve? Because they are not wanting to budge for nothing.

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[Marissa.Ann.C 21]

Unfortunately if they deem it not medically necessary, especially a revision, they won't approve. I'm sorry I went through this 2 years ago. They won't cover 2 procedures at all. It's listed under the qualifications for the surgery

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[BariatricGirl 4Life 39]

My insurance (UHC) denied me "medically unnecessary".... I did the Appeal myself before the surgeons even got word that I was denied!! On the last week (of the 30days) I called back to find I was approved!!! Yaaaaay!!

Got my surgery date today!!! It's gonna be 11/21/16! Can't wait!!!

For ANYONE who got denied or is on their way....you are correct ...the only thing you can do is: Fight, fight, fight!!!!

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