Denied 6 days before surgery

[gorgeous_vhamm 0]

I have BCBS of TX. My surgery is scheduled for Feb 8th. I have done everything possible since August. Tons and tons of medical records. Dr said it was approved then today they called said they didn't know why but I was denied and we have to cancel that I needed to contact the insurance company. They had the receptionist call me and she had nothing to say. No answers. I cried all afternoon. Was on the phone with insurance for 3 hours and he got annoyed and hung up! I kept asking to speak to a supervisor and that I needed a reason for denial and nothing but a dial tone. I am so so so so sad. Anyone have any words for me?

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[Gcarter 50]

I can only imagine your frustration! There should be an appeals process you can go through and that's where I'd start. I had to appeal a decsion for some medication once and all worked out for me. Please don't give up! File an appeal ASAP! GOD BLESS YOU. Best wishes.

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[Tasha416 9]

I have BCBS of TX. My surgery is scheduled for Feb 8th. I have done everything possible since August. Tons and tons of medical records. Dr said it was approved then today they called said they didn't know why but I was denied and we have to cancel that I needed to contact the insurance company. They had the receptionist call me and she had nothing to say. No answers. I cried all afternoon. Was on the phone with insurance for 3 hours and he got annoyed and hung up! I kept asking to speak to a supervisor and that I needed a reason for denial and nothing but a dial tone. I am so so so so sad. Anyone have any words for me?

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I was denied at first by my insurance, which is BCBS. They denied me after I jumped through all of their hoops, claiming they just changed the policy. I had to go through a 6 month nutrition program. I had become discouraged and almost gave up. I went through the 6 month program. I got my approval letter right before Christmas, and I had my surgery on 1/30/2017. Please don't give up.

Tasha

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[Berry78 4,261]

I'm speechless...

[Hugs]

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[msjessy323 184]

Don't give up . Demand an appeal and start the process asap .

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[Treadmillwalker 486]

Is the insurance through an employer? Did it change the plan coverage for 2017? Call the employers benefits manager and ask for information. You can appeal to BCBS if WLS is still a covered benefit. You need to determine this first. Good luck!

[Salee 24]

Angel Wing hugs sent 2u4 comfort. BCBS of Michigan approved to remove my excess skin on my legs & arms. Luckily the doctor scheduled it for the next week & I got it done. But after it was done, BCBS reniged on paying for any of the bill. U may think at least I got it done. No not really bc any skin removal surgery needs to be tweaked so it's uneven & huge ugly scars. I may have to file bankruptcy bc my husband died shortly afterwards so I no longer have his income to help pay bills which this surgery became. There isn't any magic surgery or magic pill. It's U that makes the difference in your own improvements even after surgery! Just don't give up on not giving up on yourself!! Even without surgery follow the postoperative eating to kick start your weight loss goal. With or without surgery it's all determination, self control & willpower always. Best wishes 2u!!

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[Purple lady 15]

Appeal, appeal, and appeal some more. You should receive a denial in writing and that denial should have a specific reason. Call insurance again and demand a written denial.

I went through 3 denials and then appealed to an external review board and got my denial reversed. I think many times insurance hopes you will get discouraged and give up. So appeal until you don't have any appeals left.

I used Lindstrom Obesity Advocates to help with my appeals. I highly recommend them if you choose to have outside help.

[jengirl714 2]

Appeal, appeal, and appeal some more. You should receive a denial in writing and that denial should have a specific reason. Call insurance again and demand a written denial.

I went through 3 denials and then appealed to an external review board and got my denial reversed. I think many times insurance hopes you will get discouraged and give up. So appeal until you don't have any appeals left.

I used Lindstrom Obesity Advocates to help with my appeals. I highly recommend them if you choose to have outside help.

I just got a denial letter yesterday. I don't qualify on BMI alone (>40), but have hypertension so I hoped to qualify with that plus a BMI of 36. I plan to appeal and my dr. referred me to Lindstrom. May I ask how much that process cost to have them advocate for you?

Thanks!

[Purple lady 15]

Appeal, appeal, and appeal some more. You should receive a denial in writing and that denial should have a specific reason. Call insurance again and demand a written denial.

I went through 3 denials and then appealed to an external review board and got my denial reversed. I think many times insurance hopes you will get discouraged and give up. So appeal until you don't have any appeals left.

I used Lindstrom Obesity Advocates to help with my appeals. I highly recommend them if you choose to have outside help.

I just got a denial letter yesterday. I don't qualify on BMI alone (>40), but have hypertension so I hoped to qualify with that plus a BMI of 36. I plan to appeal and my dr. referred me to Lindstrom. May I ask how much that process cost to have them advocate for you?

Thanks!

I would rather you speak to them directly regarding costs. But I will tell you they have flat rates, not hourly like most attorneys and I found it very reasonable. The fee they quote depends on how much assistance you need/want. They did multiple appeals for me and I only had to pay once due to the flat fee.

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[Purple lady 15]

Appeal, appeal, and appeal some more. You should receive a denial in writing and that denial should have a specific reason. Call insurance again and demand a written denial.

I went through 3 denials and then appealed to an external review board and got my denial reversed. I think many times insurance hopes you will get discouraged and give up. So appeal until you don't have any appeals left.

I used Lindstrom Obesity Advocates to help with my appeals. I highly recommend them if you choose to have outside help.

I just got a denial letter yesterday. I don't qualify on BMI alone (>40), but have hypertension so I hoped to qualify with that plus a BMI of 36. I plan to appeal and my dr. referred me to Lindstrom. May I ask how much that process cost to have them advocate for you?

Thanks!

I believe their lowest fee is $300.

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[chickee 35]

BC/BC sucks! They gave me the run around too. Not having a decision until 3 days before my surgery, and only then because I had harassed them.

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[kr8160311 36]

Will your dr do a peer to peer? My dr told me if I get denied not to worry he will do a peer to peer and that usually works. Your ins has to tell you why you were denied all of a sudden??

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[kr8160311 36]

Good luck. You keep fighting! You will get approved!

Edited February 4, 2017 by kr8160311

[Carrie1122 139]

I was there vhamm! With two denials from bsbc of north carolina.

Went through everything scheduled my endo, and picked my date. 3 days later got a denial and then paper from the insrance company followed. The reason was because my surgeon's hospital was not a baratric excellence center. i was devastated. So I found one had then transfer all my paper work down to the new hospital. No repeat of work needed.

I went and made my appt. for the cpap machine and the surgeon office called again and said that they denied my surgery. 3 hours a day 2 days later with explaining to them that the only reason you denied me in the first place. They called the surgeon's office back and they approved me right on the spot. Wait till you get the denial paper work, actually your surgeon's office should have it already or they should call for you. I if it will be the same for you as it was for me..

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