BCBS denied first submission

[IMissVegas 23]

BCBS wants me to do 6 mos supervised diet before approving band-to-sleeve revision. We are appealing it, of course since I did a nutrition program through work and had 3 sessions with a nutritionist even before my obligatory session with a dietician. Also, there is medical necessity argument for removing band due to gastritis and port pain. Still, this is discouraging. I feel like because I worked hard to lose 80 lbs in the last 3 years and my BMI is now 35, they are going to deny me. Do they want me to regain the weight and become diabetic again? It would be easy to do. My band has had the Fluid removed and I'm so stressed that it would be easy to binge.

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[sleeveisa 333]

I feel your pain, my surgery was set for today and it was cancelled because my insurance denied it. My bmi number is lower, but with all my doctors notes still. It's medical necessary too, waiting on appeal. Don't loose the hope we will get approved.

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[QueenOfTheTamazons 634]

I wouldnt stress too much. I have BCBS and they denied me twice. I recommend the following to anyone who is denied.

Write a letter describing all of the medical issues that are connected to your weight. Write about how they effect your quality of life. Write about family histories of medical issues related to weight. Describe some of your recent attempts (preband for you) at dieting and how they went. Write about the success (weightloss) and failures (port probs, pain etc) of your band. Write about how the revision will help you meet your goals.

I am sure the insurance company reps are told to deny the first time on whatever slim issue they can find. They are hoping you will take no for an answer. They also only see your chart. By writing, you show them who you are, why you need this and that you are noting going to take no for an answer.

HW 385 SW 359 Sleeved 10/5/16

[sleeveisa 333]

Thank you

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[rolosmom7 740]

Oh they denied mine the first time too. 15 months to get approval, took the surgeon writing letters and other crazy things. It'll work out!!

[IMissVegas 23]

I wouldnt stress too much. I have BCBS and they denied me twice. I recommend the following to anyone who is denied.

Write a letter describing all of the medical issues that are connected to your weight. Write about how they effect your quality of life. Write about family histories of medical issues related to weight. Describe some of your recent attempts (preband for you) at dieting and how they went. Write about the success (weightloss) and failures (port probs, pain etc) of your band. Write about how the revision will help you meet your goals.

I am sure the insurance company reps are told to deny the first time on whatever slim issue they can find. They are hoping you will take no for an answer. They also only see your chart. By writing, you show them who you are, why you need this and that you are noting going to take no for an answer.

HW 385 SW 359 Sleeved 10/5/16

Thank you for the suggestion. I'll give it a try.

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[cherieinnv 3]

I just wonder if BCBS is stalling because I've almost met my out-of-pocket limit so they will have to pay for all of the surgery and hospital. Call me cynical... so I'm going to see a surgeon this week about having a knee replacement. My knee is bone-on-bone so I don't think they can deny it. I was hoping if I lost enough weight, I wouldn't need knee surgery, but it's probably inevitable either way.

[IMissVegas 23]

Update: BCBS denied me again and it turns out my surgeon's insurance coordinator didn't turn in the letter I wrote or the dietician session information during the Pending More Info period. She says she is appealing, but I'm discouraged. I see an orthopedic surgeon tomorrow and am focusing on getting my knees and hip repaired so I can exercise.

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[WGH3IWDT 93]

Don't Slip Back into binging

PRAY AND I'LL PRAY FOR AND WITH YOU THAT BCBS, DOES THE RIGHT THING BY YOU

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[pammyjocakes 7]

Bcbs denied mine too. I am paying for it myself..sleeve surgery on December 27, 2016

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Edited November 22, 2016 by pammyjocakes