Sleeve Question

Does anyone have Care First of Maryland and had the sleeve? I have Care First. My doc office says the sleeve is not covered, Even though on the website and there covered procedures states it is.           www.gbmc.org/workfiles/ManagedCare/BlueLink_201304.pdf  

Even though my BMI is 48.5 and a failed lap band patient, they will not cover it. I still have my co-morbid problems. I have Sleep Apnea, HTN, and now gallbladder issues, and slight insulin resistance. 

My doctors office says we are at a standstill and there is nothing they can do. 

Is there a firm, lawyer, or advocacy center that will appeal for me and get an approval?

Thank you so much, 

Mike

CareFirst of Maryland has a multitude of plans...BlueChoice, BluePreferred, etc. etc.  Some are HMOs, PPOs, or high deductible plans.  You have to call CareFirst and check about your specific plan for coverage. 

Maybe if you change your care first plan they will.Call up care first talk to them yourself ask for a case manager they will be of great help to you. I have care first as a secondary behind medicare and they told me they cover the surgery if medicare. I have been concerned because I am going from a band to a vertical sleeve. From what I understand the important thing you need is letters of medical necessity as many as you can get. Have them state all the serious medical problems you have and how serious your problems. Big thing is document everything get names of everyone you speak to and what they say. You can always file an appeal with care first one after the other if all else fails file a complaint with the insurance commissioner they are located on Saint Paul Street near Mercy Hospital Saratoga and saint Paul Street.   Good Luck