DENIAL BCBS OF MN

[samlr06 2]

I received a denial from BCBS OF MN back at the end of April. I was told I only needed 3 dietician appointments. They denied due to me needing 6 dietician appointments. I completed my 6th appointment on July 1st. Called the doctor office this morning and they appealed the denial but denied again. I have done everything on the list to be approved. Anyone else having this much of a problem with insurance?

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[annagene12 4]

^{I too was denied by BCBS. It was BCBS PPO of Illinois. It was a total heartbreak. But honestly, I think they deny liberally and assume that people won't fight it. I fought it, and now my surgery is scheduled July 27th. I gave up hope for months and when they submitted my appeal I assumed the worst. And it took MONTHS.}

^{My denial was because I have a low-ish BMI (was 38, now 37), and I had mild hypertension and no other significant comorbid issue. Chronic severe back pain didn't count. That was until I conducted a sleep study and it turned out that I had mild sleep apnea, was enough to tip the odds in my favor.}

^{Keep your chin up, and talk to your surgeon's team about what you can do to appeal again. They want you to have the surgery too, honestly because they want the money & they want to help you. They are on your side. I had a three way phone call with a BCBS rep, my surgeon's coordinator and myself to find out EXACTLY what I needed to do to win my appeal. I would encourage you to do the same, it was really helpful and I recorded the phone call to protect myself because it came right from the horse's mouth.}

^{Good luck!}

Edited July 20, 2016 by annagene12

[OutsideMatchInside 10,166]

They approved me in 3 days. Their requirements are minimal depending on what what plan you have. My plan had basically no requirements just Dr recommendation and obviously be heavy enough.

I do not think they liberally deny people at all, esp BCBS IL they have a very streamlined process.

[samlr06 2]

My particular insurance has a long list of requirements. BMI of at least 35 with at least 1 comorbidities. Mine is close to 40 right now, they tested for sleep apnea which was confirmed I do have it. I did the 6 month supervised weightloss. Now they want pre and post op diet plan, documented pre and post op exercise regimen.

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[walkermy 86]

Every insurance company and even plans within companies is different. That being said, your surgeon's office should be able to determine what it takes to get you approved. Also your Surgeon can request a one on one consult with the panel or whoever from our insurance company denied your surgery. Don't take "NO" for an answer.

Good luck and keep fighting.

[missengineer 19]

I have the same insurance (BCBS of MN), I was approved in less than 2 weeks. Before I started my process, I called the insurance and asked for a copy of their policy. So I knew I had to have 6 months of supervised diet/exercise by a physician along with all the other reqs.

When you went to see the surgeon, didn't the office make you call your insurance so you woulf know what their reqs are before hand?

Have they explained the reason for the denial? They should explain exactly why you were denied a 2nd time

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Edited July 21, 2016 by missengineer

[missengineer 19]

Is your surgeon/hospital in the list of centers of excellence that BCBS has?

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[samlr06 2]

I called my insurance company before I even went to the appointment. I live in Texas and the surgeon I am seeing is a center of excellence with BCBS. The surgeons office even called the insurance company as well. They denied the appeal due to not receiving all 6 months of the dietician notes. Which the surgeons office emailed me everything they sent to them. Everything was in there. They refaxed everything to them yesterday with confirmation on both ends. So we will see. They said the appeal could take 30 days and it would be a waste of time to continue submitting if we don't have everything. Which we do.

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[missengineer 19]

Best of luck, samlr06. Hopefully it was just a missed page or two along the way on the original submittal for approval.

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[samlr06 2]

Thank you missengineer

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[Kendell Thatsme 39]

I was denied for not having 6 months weight ins I only had 4 so now I have to wait and do 2 more I hope they won't deny me

[samlr06 2]

I am hoping I don't get denied again, it is so frustrating. Crossing my fingers for everyone having to go through this.

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[netters817 3]

I have BCBS of MN as well and I'm on week 2 of waiting for the approval. My surgeons office said that they are notorious for a long wait time but don't get many denials. Probably due to the office's diligence with submitting everything they ask for, plus more. Good luck to you (and me!).

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[trekker954 421]

I knew, and my surgeon's office listed all of BCBS requirements. I gathered all of the information I needed from my PCP, my long history of weight loss and gain under PCP care (had to be consistent of four months) I think I had a year. Three year history of being overweight (I think I got doctor visits notes for whatever but showed my weight going back to 2008 through 2015). PCP wrote up a very good referral for WLS. I did have to get some other clearances, but not for BCBS. Then per the surgeon, had to get the psych for insurance too. I did all the work making sure all the documentation was in order and delivered to the insurance girl to send in. I was approved within 2 days.