insurance will not cover ds only gastric bypass please help

federal bc/bs and since im having it done in new jersey they went thru the horizon bc of jersey

what is the reason they denied you?  the reason is on the denial letter. post more information,   many times ins. cos deny a certain type of surgery when in actuality it is covered.  since you don't have a bariatric surgery exclusion, overturning that is not difficult

I have to call the new dr on this one... I got a letter from the nj bc stating they needed more information and that my case was closed... then 3 days later i get a call from the new surgeons office wanting to set up the surgery for the bypass... she said it was approved.. the only reason i knew i wasnt getting the ds was because the new dr ofc called me said the insurance will not cover the ds  and that dr was submitting for the gastric bypass..   thanks.

um first of all, you need to find a new dr, any dr that would submit for RNY just cause it was covered and not talk to you about it, i would RUN to the nearest exit sign and never look back and it sounds like you need a revision to your sleeve, this is very dangerous surgery, find a vetted revision surgeon, there are few-you are trusting this surgeon to perform surgery on you?  don't let someone do that to you...you deserve better.  any medical procedure that is requested AND denied, has to be denied in writing to the member.  this sounds very shady...

i am going to call bc again and see why the ds is not covered since i already have the sleeve part done.. the first surgeon i was told by the 2nd one did not do the sleeve correctly.. i only lost 52lbs in a year and had no restricion after 6 months.  but the diabetes never went or got any better... so I found a dr in jersey that will do a revision for me..  thanks for your input..

On what information are you saying they won't pay for it? Have any papers officialy requesting a DS been submitted? Who submitted them? The reason I ask is because there is a code for the DS procedure and whomever told you that may have just looked and didn't see DS so assumed it isn't covered. It may not be but for accuracy get the medical procedure code and request your insurance companies EOB, explanation of benefits. You can usually call and have them research the medical code. I was on my way to RnY when I found out about DS and switched while awaiting for approval for RnY. I too have the Blues but not Federal, I have Highmark Blues. Basically what I'm saying is to double and triple check.