Question

[blondie2 0]

I just had my 6 mo. appt./weigh in yesterday. Yipee I am done! However, on my last denial letter they stated the reason why I was denied was that my 6 month was not completed. I am going to fax my completed 6 month evaluation Monday. If it was stated the only reason why I was not approved, shouldn't I be approved when everything is resubmitted. I have met all of the other requirements. I have bcbs of IL. :cool:

[Bobbie155 0]

Why did they even submit a claim before you had everything done that you need? Do you have to have a Psyc Eval? If so I would not submit it until you have everything done. I have BCBS in Pennsylvania and it only took 2 days to get an approval.

[blondie2 0]

yes, I have done the seminar, nut. psych eval ect. The dr. office submitted it for preauth. and it was denied until I recieved my 6 month.

[adagray 1]

Why did they even submit a claim before you had everything done that you need? Do you have to have a Psyc Eval? If so I would not submit it until you have everything done. I have BCBS in Pennsylvania and it only took 2 days to get an approval.

I know w/Aetna, you can submit before the 6 month diet just to make sure all other rqmts have been met. I think its a great idea that way if there is anything else they need, you can take care of it during the same 6 month period rather than wait until the end and be unpleasantly surprised that you are still not 'done'.

Anyway, I would think this means you are good to go, but maybe check w/your bariatric surgeon's office to put your mind at ease. I know I'm gonna make sure mine submits everything BEFORE the 6 month diet so I can know if I have a fight on my hands.

[Bobbie155 0]

Will they send you a list of things that you don't have completed rather than give you one reason?

[blondie2 0]

I'm not sure how that works- I know that in my policy there is no exclusions for bariatric surgery. So I think when they submitted they wanted the specifics of what I needed- that way I can take care of it during the 6 month period.