Blue Cross/Blue Shield Sleeve Coverage

Hello All, I live in Oklahoma and have been denied sleeve coverage by bc/bs as investigational. I'm preparing an appeal to my employer's benefit division. I have appeal letter's from my P.C.P. and Bariatric Surgeon, I am on anti-inflammatory  meds. and will only consider the sleeve. Any thoughts or suggestions. Thanks

good luck,  i live in california and anthem blue cross denied d/t investigational,  i need anti inflammatory meds and i'm hoping to win my appeal based on that fact,  so here's hoping that we both win our appeal.  my bariatric surgeon doesn't appeal the sleeve so i'm going it alone, but i plan on going down fighting,  hoping not to go down, 

That's interesting! I also have Anthem BC in Southern California... and I was recently approved for BOTH RNY and VSG, at my surgeon's request. Because of anemia issues, I may end up going with VSG over RNY, but we're waiting on all of the pre-op labs to come back. Of course, I'm on an HMO plan and I don't know if that makes any difference, but I can tell you that my approval went through within just a day or two.

My HMO used to use your surgeon (in Burbank, right****il abouit 7-8 months ago, but they work with another one now... one more local. I'm not sure if it's because of the change in surgeons or not.

as per above , i appealed bc to state in cal and won. ibuprohin was part of it. read my blog. if you want to see my appeal letter i will email it to you as i have to many others. gl. d

Diane,

Hi, I just got denied from bc here in texas.  I am asking my physician to appeal it.  I was a little confused because a co-worker of mine, with the exact coverage as myself, had her VSG done in April of this year and BC covered it.  So I am appealing.  I am adament on wanting the sleeve.  My friend feels great and is losing the weight.  The thing that concerns me is that the Doctors office made it seem like it was a lengthy process to appeal.  I would really like to know what you did on your appeal.  Unfortunately, I am new to this blogging stuff and I couldnt find your appeal letter.  I would love it if you would email me [email protected].  I really need some help in this appeal process.  Thanks

Suzanne

Hi I have Anthem, and the CPT CODE my doctors office used Anthem is saying it's considered Imvestigational/Experimental... I was wondering if you still had a copy of your 2nd Appeal letter OR IF you could offer any suggestions on how I can get approved....I have a dilated Stoma, Gerd, Reflux, HBP. Lower back problems, my BMI meets the requirements...Also this is for a Revision to RNY...I APPRECIATED ANYTHING YOU CAN HELP WITH.

Hi, There all a lot of appeal letter samples on this site.  Just type in VSG appeal letter in search. 

Here are a couple of them:

http://www.obesityhelp.com/forums/VSG/4139238/Insurance-appe al-I-need-your-best-scientific-articles/

 

http://verticalsleevetalk.com/insurance-financing/1496-my-ap peal-draft-w-references.html

read my blog. i appealed to the state imr board and won and bc covered my vsg after denial as investigational. i can email my appeal letter to you if you want. D

Hi i'm pretty sure yours is the appeal letter that i used as the basis of mine,  i have a question,  a gal from anthem faxed me my denial, my hmo sent me a letter said "this is not a denial of service" but procedure experimental   has to go to anthem for decision,  called anthem several times and was told this dept doesn't do this(hmo) call your provider,  called them back told to appeal,  on 30 day of appeal told you haven't been denied yet ,  cannot appeal,  then told oh that dept doesn't know this is part of their job?? wtf?? so they denied me, a gal  faxed me the letter so i then faxed my appeal again,  then when i got home the letter was here and it says i can skip the appeal with them and ask for the IMR,  so what should i do now,  should i wait for anthem to deny the appeal or can i be appealing with them and ask for the IMR??   very frustrating,  gotta go to work,  thanks for your help with this  jeani

just quit goofing around and go to the imr. they respond in 30 days. there is a different board with the cal insurance dept if you have an hmo vs traditional health insurance. go to the cal insurance dept web site and call them and figure out which dept to go to. they are really nice and helpful. and send all correspondence with post office tracking. insurance companies pretend like they don't recieve stuff. tell the imr that they haven't responded in the 30 days so you are going to imr. get the ball rolling and stop their fooling around. kick a$$!!!. D