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Does anyone know what a Pier to Pier is?????

Esta F.
on 5/14/12 8:03 am - IL
RNY on 07/25/12
I was denied for my WLS because of lack of necessity and that BCBS of IL. said my surgeons office didn't send over the paperwork showing that i was educated for post-op care.  My surgeons office is telling me that they have to do something called a Pier to Pier to reverse the denial.  Has anyone ever had this happen?  I thought all my surgeons office would have to do is send over the paperwork showing that i was educated for post-op care...now there is the Pier to Pier thing.  This is all getting so frustrating!


  
 

Judi J.
on 5/14/12 8:07 am - MN
I'm no insurance guru but it is Peer to Peer like Doctor to Doctor where your Doctor can specifically talk to the insurance company. So I think it is promising.

I know in the old days BCBS of IL was a tough one to get approval from. I hope the Peer to Peer conference works. Hang in there!
Esta F.
on 5/14/12 8:09 am - IL
RNY on 07/25/12
thank you i'm really trying!  I though my BMI alone would have approved me but i guess not.  I'm keeping my fingers crossed!


  
 

Judi J.
on 5/14/12 8:11 am - MN
sounds like there was maybe a requirement for you to meet with a nutritionist or something and they just didn't get the paperwork?  It wouldn't hurt to call your surgeon's office and ask them specifically what is missing, just in case there is something you can do.  good luck!
kathkeb
on 5/14/12 8:35 am
it could be that your employer has a committee that does a 'peer to peer' review of claims.

My company (for example) does not cover Bariatric procedures, however it does set aside an amount of money to cover very special cir****tances ----- and so people with extreme needs (significant co-morbidities, etc) can request an appeal, and those situations are reviewed by a peer to peer comitted -- and then approved or denied again.

You might be able to google "peer to peer insurance reviews" to get more info.

Kathy
Kath

  
SandieMc49
on 5/14/12 10:33 am
I work in health insurance and a peer-peer is called a "doc to doc" in my environment.  BUT, I highly doubt that a doc-to-doc is necessary when only paperwork is missing. 

Please make sure YOU keep on top of this.  YOU call your surgeons office and see if they have set anything up yet; OR if they have sent over the required paperwork.  Then, YOU contact the insurance company to make sure they have received it.

It really shouldn't be that big of a deal - but YOU have to drive this to make this happen.  Best of luck to you.

Sandie
Esta F.
on 5/14/12 1:48 pm - IL
RNY on 07/25/12
thanks!  just called BCBS and they told me all they're missing is some paperwork and that the Peer to Peer thing is not necessary.  So i called my surgeons office and of course the person who handles all this is not in and i had to leave another VM.  This has been going on since April 18th!  Seriously thinking about switching surgeons!


  
 

southernlady5464
on 5/14/12 10:51 am
DS on 01/24/11 with
My peer to peer was denied...

Ended up the reason was that while they approved the surgery, they wanted me to stay IN state. Had a devil of a time finding a surgeon who was willing to do a DS on a lightweight that WAS on my list of providers but I did finally find one.

Once I found my surgeon, they had no trouble approving the surgery.

Liz

Duodenal Switch (Lap) 01-24-11 | Surgeon: Stephen Boyce | High weight: 250 in 2002 | Surgery weight: 203 | Lowest weight: 121 | Current weight: 140 | Goal weight: 135