Hi Ginger,

I was exactly like you....CRAZY nervous about being denied....and i WAS!!  And so was my daughter!  But I appealled both times and won the appeal on both.  Then, my two sons went through the approval process and they were approved with no problems at all!

I don't have BCBS, I have Aetna.  They have a clinical bulletin that spells out the requirements that you need to meet in order to get approved,  I printed that and used it as my bible and checklist to make sure everything on that list was covered.  I was just like you though...couldn't sleep or think about anything else except scared to death I would get denied.

The reason I was denied is because my surgeon's office turned in my paperwork too soon and I had not finished my physician supervised diet yet!  So, I got denied, continued and completed my pcp supervised diet, filed the appeal, and was approved.

My daughter was denied because they said she did not 'show proof of 2 year history of obesity'  We put together her appeal by submitting 4 years of office notes from our physician showing her BMI being >40 for four years!  She was eventually approved also. 

Then, about four months later, my 2 sons information was submitted for approval an they were both approved within a couple weeks with no trouble at all!

I guess my suggestion to you would be to get a copy of your insurance requirements for what you need to do to to get approved,  Go over it with a fine tooth comb and make sure you have met all of their requirements and that when you (or your physician or surgeon's office) submit for approval, they have that checklist and all the required information is submitted. 

Approvals are usually pretty quick, but if you have to appeal, it can then take up to an additional 30 days and the waiting is nerve wracking!!

Good Luck to you on your approval!  Keep me posted!

Nan

UHC requires a six month support group requirement for my approval process. I attended several support groups for months and then UHC told me none of the groups are acceptable because they are not conducted by a medical professional. 

 UHC wants me to start my six month support group requirement over. I complete all of my insurance hoops this week. I think I will submit my paperwork and see what happens. If I am denied how long does an appeal take?  I believe my appeal would go faster than five more months of support group meetings. I strongly believe support group requirement should not prevent anyone from having surgery. Any insight please?

Stephanie

 Hi there,
I am in the "in process" boat.  And this is for the referral from my pcm to the bariatric surgeon (civilian)  Does the surgeon also have to put in a request for the surgery, or will the first one cover it?  I'm thinking that's why it's taking so long? I'm getting annoyed.  I have Tricare Prime North.  My doctor's office put the referral in on March 1.  (although I was seen on the 23rd - grrr) Figured I'd hear something other than "in process" by now.  I'm trying to be patient, but my consult appointment is on Friday the 11th.
I am 5'3" and 260.  I also have high blood pressure, elevated cholesterol, and sleep apnea.  I sure hope I don't get denied.  I hope I can join you on the losers bench, too!  
Okay, thanks for listening.  I think I'll give Tricare a call today.

Hello there,I'm sorry your going through this. If you dont have a copy already,get a copy of your coverage that specifies whether or not you have covered.If you have documented who told you it was a covered benefit and get copies of whatever code was given would be helpful too. I'm really not familar with the plan that you have,but I would definitely appeal,but I worry that if you have signed a document stating you'll pay for services if not covered you may still be responsible. It just doesnt make sense if it was a covered benefit why they would have you sign something like that? You may have to back track and request aperwork that states what they have done to make sure they did document everything correctly.Thats the only way to find out what they have done before you appeal. I hope that helps.I wish you the best.

I'm eligible on 4/8/11 to send my packet into the insurance co for approval and I am CRAZY nervous that I'll be denied.  I don't know why... maybe we all have these fears.  Anyway, if you were denied, why were you? 

Also, if you have BCBS of FL..... what has your experience been with them?  Were you denied, if so, why? If you were approved, was it a fairly easy process?  Approved the first time you sent your info?

Thanks!
Ginger