How do you appeal insurance denials?
I desperately believe the sleeve is my surgery that is needed and with my surgeon too. My insurance carrier approved RNY or lap-band. What advise and steps do you all know or have for appealing with insurance carrier.
You help is SOOOOOOO appreciated! I want to fight for what I believe I need! I pay very good money for this plan monthly and am not going down without a fight, but don't know where to begin!
PLEASE HELP!
You help is SOOOOOOO appreciated! I want to fight for what I believe I need! I pay very good money for this plan monthly and am not going down without a fight, but don't know where to begin!
PLEASE HELP!
Hi there,
My advice to you is to call your insurance company, and ask to speak to a nurse who can review the policy with you. Another important question to ask is if they have any pending updates with regards to the sleeve. For example: I have BCBS of MN, and I my surgeon was sure they would deny it, but I asked him to submit the paperwork anyway, and I would pray on it. About a week after they submitted, I called BCBS and spoke to a nurse who explained the policy to me, but she was like "well honey seems you're in luck." I said why, she said as of Aug 29, 2011 their policy was being updated to reflect theat the sleeve was deemed "medically necessary" instead of "investigational," which means they will start paying for it if you qualify. I cannot begin to tell you the range of emotions I felt at that moment. I'm not sure what faith you have, but the GOD I serve is a deliverer! Hang in there, it will happen for you as well. Best of luck to you.
My advice to you is to call your insurance company, and ask to speak to a nurse who can review the policy with you. Another important question to ask is if they have any pending updates with regards to the sleeve. For example: I have BCBS of MN, and I my surgeon was sure they would deny it, but I asked him to submit the paperwork anyway, and I would pray on it. About a week after they submitted, I called BCBS and spoke to a nurse who explained the policy to me, but she was like "well honey seems you're in luck." I said why, she said as of Aug 29, 2011 their policy was being updated to reflect theat the sleeve was deemed "medically necessary" instead of "investigational," which means they will start paying for it if you qualify. I cannot begin to tell you the range of emotions I felt at that moment. I'm not sure what faith you have, but the GOD I serve is a deliverer! Hang in there, it will happen for you as well. Best of luck to you.
Robin
Thanks so much for the info and support. I certainly have faith in my God and I don't know where I would have been in life without it and him!
I am going to fight until the death with the insurance company and place it in the lords hands along with my fight and all of the great information you all have here on this forum!!
Thanks so much!
I am going to fight until the death with the insurance company and place it in the lords hands along with my fight and all of the great information you all have here on this forum!!
Thanks so much!
They should have included information on how to appeal. I would call your doctors office first and find out if they will do it for you.
Did they give you a reason for the denial? My old insurance did the same thing....approved for RNY or Lap Band but not the sleeve. They said there needed to be a documented medical reason why I needed a sleeve vs a bypass....and not just my preference. Some places are still holding on to the outdated idea that RNY is the gold standard.
Did they give you a reason for the denial? My old insurance did the same thing....approved for RNY or Lap Band but not the sleeve. They said there needed to be a documented medical reason why I needed a sleeve vs a bypass....and not just my preference. Some places are still holding on to the outdated idea that RNY is the gold standard.
Your Dr's office should help you with the appeals process. That is their job.
If you need some ideas on an appeal letter, I have the one I used to win my appeal. (Thanks to many here on OH) My surgeon told me it was very good and they would use it for others that were denied VSG. I have it posted on my page.
Best wishes for your successful appeal!
Brenda
If you need some ideas on an appeal letter, I have the one I used to win my appeal. (Thanks to many here on OH) My surgeon told me it was very good and they would use it for others that were denied VSG. I have it posted on my page.
Best wishes for your successful appeal!
Brenda
Brenda,
That is a great letter and believe it or not much you have in your letter applies to me also! How long did your appeal process take? I know you were denied the first time but did they approve the second time?
I am willing to fight as long and hard as I need to do!
Thanks so much for such wonderful information!
That is a great letter and believe it or not much you have in your letter applies to me also! How long did your appeal process take? I know you were denied the first time but did they approve the second time?
I am willing to fight as long and hard as I need to do!
Thanks so much for such wonderful information!
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