HUGE News from DeLarla

[VegasBones 0]

Lots of folks have been waiting for this news, so hopefully this will help some of you "self-paid victims of erosion" finally relax. After 2 years of appeals, Blue Cross finally reversed their decision, and they just covered the $37,500.00 two-day hospital stay for reversal surgery.

For the record, band placement was not covered, so insurance refused to cover the emergency removal (due to erosion) since the initial procedure isn't covered. After 2 years of fighting their decision, Blue Cross responded:

"After careful review of the additional information provided, it was determined the previous denial will be overturned as the services are, medically necessary based on the following review. Blue Cross reviewed your appeal regarding the denial of your acute in-patient stay in Community Memorial 12/27 through 12/29/05. Blue Cross considered your hospitalization after reviewing the medical records submitted as an urgent planned admission to a non-participating provider. The reviewers included a director and an Appeals Nurse (RN). All deductibles and co-payments will apply as an urgent/emergent admission to a non par hospital in accordance with your Blue Cross benefit plan."

Never give up the fight!