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Revision denied due to being experimental

iagree2shine

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iagree2shine    52

iagree2shine
Posted

I have never heard that before! And the head of the medical board for bcbsil didn't event want to hear my case and is refusing to allow anymore appeals. We only had one appeal and that was peer to peer. He said the only complication from the sleeve is a leak and not GERD. So I have to go to the Insurance board of IL. Never would have imagined. And he is not allowing them to treat my hernia. He told them to treat me medically and not surgically.

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James Marusek    5,244

James Marusek
Posted

How do you treat a hernia medically and not surgically? It seems sometimes the worse problems one has with weight loss surgery is dealing with the insurance companies and not the surgery itself.

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iagree2shine    52

iagree2shine
Posted

I know that's what I've been telling people. It's the insurance that makes it difficult and I didn't know the insurance company can tell the doctors how to treat.

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Djmohr    6,965

Djmohr
Posted

@@iagree2shine

I am so sorry. That is truly disappointing. Don't give up, go to the state if need be.

The hernia part is even more ridiculous!

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iagree2shine    52

iagree2shine
Posted

My finally 30 day wait appeal has been denied! I'm stuck with no real answers. They kept finding things out of no where. I'm out of appeals and my job said I can't go to the insurance board due to the type of way our insurance is.

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Marissa.Ann.C    21

Marissa.Ann.C
Posted

BCBS doesn't approve any revisions as they consider them "not medically necessary" and "experimental". Legally I believe you are allowed 3 appeals

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LisaMergs    2,854

LisaMergs
Posted

I have never heard that before! And the head of the medical board for bcbsil didn't event want to hear my case and is refusing to allow anymore appeals. We only had one appeal and that was peer to peer. He said the only complication from the sleeve is a leak and not GERD. So I have to go to the Insurance board of IL. Never would have imagined. And he is not allowing them to treat my hernia. He told them to treat me medically and not surgically.

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Can you please give me the name of the medical board head?

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iagree2shine    52

iagree2shine
Posted

@@LisaMergs I tried to get his name, bcbsil told me due to regulations I couldn't have his name.

I gave up trying, figured easier just to switch to a wls friendly insurance. Even my surgeon has yet to stop trying. I have never heard him cuss a day in my life until he spoke of this man.

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LisaMergs    2,854

LisaMergs
Posted

@@LisaMergs I tried to get his name, bcbsil told me due to regulations I couldn't have his name.

I gave up trying, figured easier just to switch to a wls friendly insurance. Even my surgeon has yet to stop trying. I have never heard him cuss a day in my life until he spoke of this man.

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I'll find out. Let me make a couple of calls. My cousin is in charge of all of the doctors in a large health care system here in the greater Chicagoland area, and she loves a challenge

Just sent her a text...

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LisaMergs    2,854

LisaMergs
Posted

Ok. Got it!!! I will PM you! Have her address, too!

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Go To Topic Listing Revision Weight Loss Surgery Forums (NEW!)

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