Xpost - YEP... Anthem BC PPO Denied my VSG today...

And I am not mad about it either.   I knew it was coming thanks to my OH family.  I will appeal first thing in the morning.   Fellow Marchers... I won't be on your journey in March however - I WILL see you in the winner's circle soon!

All the best for your continued success...

To Be Me Again

I am very sorry to hear that...but don't give up. And we are here for you.

HUGS
JOY

I am so sorry to hear that!  You have such a good attitude, though, which makes you such a total WINNER!  I have Blue Cross/Anthem HMO and my surgery was approved in just a couple weeks - no problem - but I have heard the PPO is harder to get approval.  Hang in there! 

Why did they deny it?  Was there anything missing when the dr office submitted it.  If that is the case get on the phone with blue cross and ask to speak to the nurse it was assigned to and also talk to the dr office.  Is VSG a procedure covered by blue cross.  Do you meet their criteria re BMI etc etc....
Liz

That so strange, I know every case is different, but I have Anthem BC-PPO, and they approved me for the DS with know problem. VSG, is less invasive then DS too. You need to call them and ask them specifically why you were denied.

Doc,

Thank you everyone for your support!  I was denied VSG due to "investigational".   I called this morning to appeal and requested a Bariatric surgeon review my appeal case and not some random dr such as a OBGYN or a brain surgeon.  I would have never thought to ask who would be making these decisions for approval or denial had it not been for my OH family having my back.  So in any case... the appeal process seems to be fairly easy... the greivence rep was really nice and explained the process etc.  I gave my appeal over the phone and he will be sending me a transcribed letter of the appeal I gave over the phone.  I also asked that my surgeon be consulted in a peer to peer review.  He said that's done if I recieve a 2nd denial.    So... 30 days from today - I should hear back. They had better not deny me again or else it's WAR - Anthem Blue Cross PPO of CA!


Thanks again...

And best for your continued success!!