Insurance denied - help!

nolamom
on 7/27/20 8:53 am

Hi,

I have BC/BS and was told that they cover revisional surgery. I did all the things they require (nutritionist, psychiatrist, etc) but was received a denial. I am waiting on my patient advocate to call me back.

Any advice would be greatly appreciated.

Janet P.
on 7/28/20 7:05 am
On July 27, 2020 at 3:53 PM Pacific Time, nolamom wrote:

Hi,

I have BC/BS and was told that they cover revisional surgery. I did all the things they require (nutritionist, psychiatrist, etc) but was received a denial. I am waiting on my patient advocate to call me back.

Any advice would be greatly appreciated.

My experience is a long time ago, but when I was initially denied (they covered WLS but not the DS back then - experimental), because my company had a self-funding insurance plan, I was able to appeal directly to the company (with the help of my HR rep) and won.

First see why they denied you, and then figure out with the help of the advocate what your next step is. I would also contact your HR/benefits person to see if they can help.

BC/BS has dozens if not hundreds of policies - it all depends on the policy chosen by your company, what state you live in -- so many factors.

Good luck!

Janet in Leesburg
DS 2/25/03
Hazem Elariny
-175

nolamom
on 7/28/20 8:19 am

Janet,

Thank you! I have a call in to my advocate. I just was devastated yesterday when I got the denial. Thanks for the support!

hollykim
on 7/29/20 9:56 am - Nashville, TN
Revision on 03/18/15 with
On July 27, 2020 at 3:53 PM Pacific Time, nolamom wrote:

Hi,

I have BC/BS and was told that they cover revisional surgery. I did all the things they require (nutritionist, psychiatrist, etc) but was received a denial. I am waiting on my patient advocate to call me back.

Any advice would be greatly appreciated.

many plans cover revision of there is a mechanical malfunction on the original surgery. They often don't cover revision if there is no surgical problem. As in, they don't cover it if the problem is that one eats off plan and has gained. Don't know your situation but this is what I know.

 


          

 

nolamom
on 7/29/20 12:24 pm

Hollykim,

Thanks for your response. That is what the denial says so I'm not sure there will be a winning appeal.

hollykim
on 7/29/20 1:40 pm - Nashville, TN
Revision on 03/18/15 with
On July 29, 2020 at 7:24 PM Pacific Time, nolamom wrote:

Hollykim,

Thanks for your response. That is what the denial says so I'm not sure there will be a winning appeal.

have you had any testing to shoe any malformation or mechanical problems?

 


          

 

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