Denied Today by BCBSNC medical society

[dillon1205 0]

I called into my insurance company today to check on my approval before the holiday to find out that I have been denied. They said that the only thing they could tell me was "not medically needed". So how can I prove it is needed. Should I get my PCP and surgery DR to help the the appeal letter. Does anyone else have BCBSNC and been denied? How many people usually get denied and the win their appeal? I am just so confused and want to get the appeal process going.

[Mrsace13 0]

I am waiting on mine now, I have B/C B/S OH. I am so worried and hate waiting.

Did they tell you why they thought it wasn't? What is your BMI? Mine is a 38 or 39 in that area and I am so worried they are going to say that to me too. Did they give you any reason so you know what you need to fight back?

[dillon1205 0]

My BMI is 48. And my insurance states that it just needs to be higher then 40 for 5 years and mine has. I hope it is just a clerical error. I will get my letter in the mail this weekend hopefully go from there with what I need to be excepted. They just submitted my paperwork on Monday and it was already denied this morning. So frustrating.........

[nazzy 1]

i know if u have bad knees exc.. this could be reason medically n ess.i had knee replaacements last year so i went on the 6 months diet bcbs wanted,and my finally one my dr put medical ness and i was banded tg

[needtoseemeagain 0]

My BMI is 48. And my insurance states that it just needs to be higher then 40 for 5 years and mine has. I hope it is just a clerical error. I will get my letter in the mail this weekend hopefully go from there with what I need to be excepted. They just submitted my paperwork on Monday and it was already denied this morning. So frustrating.........

I doubt it is a typo, but there could be some additional information needed from your doctor. Try to relax, sometimes a denial can be resolved rather quickly. After the holiday the doctors office can call and find out what the denial is for and should let you know the best & fastest remedy.

[dillon1205 0]

:eek:Thank you that is what I am hopeing too. That all that is needed is so additional info from my dr. Does anyone know that social anixety b/c of my weight would help with the "medically needed". I just really want to be proactive and get all the right wording and weight symptoms into the insurace so that they know I really do medically need this mind and body...

[Maggies 0]

I was denied the first time and my surgeon talked to the ins. company and found out that my sleep study was not included in the original packet. So they resubmitted it to ins. with the sleep study and i was approved. I have sleep apnea and was over 100lbs overweight. So there is always hope. It could be just a simple oversight. Good luck.

Maggies:shades_smile: