Need BC/BS Ammo

HI, it has been ages since I posted! I got real discouraged when BC/BS had me jump through hoops and then at the last minute said they denied me because they don't cover revisions. What a bunch of pooh! Why did they have me jumping then? I had the stapling done in 1996 and the doctor said he thinks I should have the RNY....I gave up, and now I have a second wind and want to appeal. Does anyone have any successful experience getting BC/BS to pay for a revision and who was the doctors office that was successful. Thanks, Sherry

Hi, I just won my appeal with them. Mine is Horizon, NJ Plus but they are under BC/BS. If you want, I can email you a copy of the letter. I will share my appeal letter with anyone that can use it. I worked hard on it and hope it will also help someone else. So email me if you would like a copy.

Kathy, I have worked all day on my appeal letter, but every time I re-read it, I can hear the anger in it, so I keep revising. I would LOVE to have a cope of your letter to use as a template. Can you send it via "Word" prgram? If so, my address is [email protected] I am so frustrated that I was going to give up and just except defeat, but I just have to try one last time. Thank you for your help!! Regards, Sherry

Sherry, I just won my battle with the appeal as well. I have BCBS of Illinois and I found out yesterday that my denial was overturned and approved for surgery. Kathy helped me with her appeal letter as well and that helped me out a lot. If you need some additional information or another letter to review, please let me know. They need to know your frustration and at the same time stating the facts as to why you need to have this revision. Take Care, Shana