Question:
Is it a bad sign when your case has been sent to the review board?
I have BCBS of Illinois (PPO) and it seems as if it is taking forever to get an answer. I call at least twice a week, and now they tell me that my case had to be sent to a review board for final determination. Is this a bad sign? I'm trying to prepare mentally for denial. Has anyone else had his or her case sent to the review board? How long did it take? What was the outcome? Thanks! — Stacey J. (posted on March 6, 2002)
March 5, 2002
My case went to the review board, I think most insuance companies have a
review board. Anyway it took two weeks for approval.
— Terry F.
March 6, 2002
My surgeon told me that the insurance companies all require that cases be
sent to a review board as of January 1st. I am still waiting to hear about
my surgery date. Had my initial consult on November 5th
— Shirley M.
March 6, 2002
Mine went to a review board also. It was approved!!! after 2 days. Don't be
concerned. If they say no keep trying!!!
— Sheila H.
March 6, 2002
Hi, Although I'm not an insurance expert, I'm pretty sure that all WLS
cases go to a review board. Mine, went to a review board, just to make
sure that I fit all the guidelines for WLS. Most insurance, (not all)
companies cover WLS with specific guidelines, the review board just makes
sure that those guidelines are met. :)
— Carey N.
March 6, 2002
My pcp told me my wls was going to the medical group review board.They meet
every month to do this. Insurance co. give the medical groups up with so
much money every year and its up to the medical group to determine how
the money is spent. In my case, My pcp personnally went to the review
meeting and got my wls approved!!! If the medical group review board save
money ( have money left over after the year) the doctors get cash bonuses.)
Thats why we run into uncaring doctors who are against wls. Some won't help
at all, no letter etc.. They act like we are crazy for wanting this and
should try the ole fashion way again. Think these medical doctors don't
talk about this behind closed doors?? Better think again!!!!!
— Laura G.
March 6, 2002
In this case, referring it to the review board is a good sign.
If they considered your wls to be "not medically necessary, they
would have denied it outright. Generally, review boards meet once
a month and are chaired my the insurer's Medical Director. Sometimes
if helps if your doctor (not the surgeon..) speaks directly to the
insurer's medical director before the board meets.
— [Anonymous]
March 6, 2002
Some insurance companies will approve it right away. Because this
procedure can be costly and also not your typical surgery, some insurance
companies will want to do this. After my procedure was complete and the
insurance company received the bill, they audited it before paying the
bill.
— dolphins94
March 6, 2002
I also have BCBS of IL, I was approved in just a little over 24hrs after
going to the review board. I have co-morbidities, I am 5/4 255 with a bmi
of 44, they found medical necessity for me to have the surgery. Keep
calling them, they keep records in their computer as to when you called and
what for. You sometimes need to keep after them otherwise things fall thru
the cracks.
— ChristineB
March 6, 2002
I have BCBS of Alabama PPO. I called today and mine is also being sent to
medical review. I asked and the lady told me that all wls surgerys are sent
to medical review. Good Luck!!
— SBBYRAM
March 7, 2002
My case was sent to a review board because they did not have enough
information and the doctor's office would not get it to them in time. The
review board approved it very quickly though.
— cindy Q.
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