Denial Letter, AKA Adventures in Asininity (x-post)
So, i received my denial letter today, all of 3 sentences long from BCBS, and here is what they wrote:
"The records sent to us do not meet the coverage criteria for the service requested.
The specific reasons for this decision:
Per MD review, deny duodenal switch procedure. Appears to be a reasonable can. for bariatric surg., but the duod switch is is not shown to be med nec. and is not elig for coverage."
That's it. Word for word, right down to the double is. My first thought- seriously? you don't even have the decency to actually SPELL out the words in whole, let alone use proper sentence structure, on TOP of denying me? Then there's the even more ridiculous part- that I don't meet the coverage criteria for the service requested, but yet I appear to be a reasonable candidate for bariatric surgery, yet the DS is not shown to be medically necissary.. **Scratching Head**
Um, yeah oh great and wise insurance MD's with your vast grasp of all things medical & vocabulary, correct me if I'm wrong but, isn't the DS considered a bariatric surgery??
So I call the handy dandy number on the back of the letter seeking out a more definite answer for the denial and the gal I got ahold of had no clue what to say, let alone have access to the records. "?" #2, why the h**l do you list a number on the back of a denial letter stating to call this person for further answers when that person doesn't know their head from their a$$??
OK, Ok, stepping off my soapbox now here... Anyone with insight that can decifer what on earth they were saying...?? Thanks!!
"The records sent to us do not meet the coverage criteria for the service requested.
The specific reasons for this decision:
Per MD review, deny duodenal switch procedure. Appears to be a reasonable can. for bariatric surg., but the duod switch is is not shown to be med nec. and is not elig for coverage."
That's it. Word for word, right down to the double is. My first thought- seriously? you don't even have the decency to actually SPELL out the words in whole, let alone use proper sentence structure, on TOP of denying me? Then there's the even more ridiculous part- that I don't meet the coverage criteria for the service requested, but yet I appear to be a reasonable candidate for bariatric surgery, yet the DS is not shown to be medically necissary.. **Scratching Head**
Um, yeah oh great and wise insurance MD's with your vast grasp of all things medical & vocabulary, correct me if I'm wrong but, isn't the DS considered a bariatric surgery?? So I call the handy dandy number on the back of the letter seeking out a more definite answer for the denial and the gal I got ahold of had no clue what to say, let alone have access to the records. "?" #2, why the h**l do you list a number on the back of a denial letter stating to call this person for further answers when that person doesn't know their head from their a$$??
OK, Ok, stepping off my soapbox now here... Anyone with insight that can decifer what on earth they were saying...?? Thanks!!
Every opinion we share, every favor we perform, every moment we intently listen to someone talk about themselves is our opportunity to pass along something positive to a person who needs us.
LOL! My word! Talk about bad transcription skills. eek!
When you get your next letter assigning your Liason from BCBS, contact that person and ask them to decipher since it was obviously a poor transcription job.
And if I were to decipher? It's because you do not have a BMI of 50 or more. Simply put.
When you get your next letter assigning your Liason from BCBS, contact that person and ask them to decipher since it was obviously a poor transcription job.
And if I were to decipher? It's because you do not have a BMI of 50 or more. Simply put.
I'm printing off EVERY page of the following link and adding it to my binder for appealing...'
This is from Empire BCBS/MN, from BCBS/MN OWN POLICY MANUAL as of February 2009!! If it's good enough for them, why not me?? (ok, so that probably doesnt sound right, but I usually don't make a whole lot of sense! LOL!)
It literally lays out for me why they should approve the surgery!!! 25 pages worth, right down to every sighted study backing it up!!
http://www.empireblue.com/medicalpolicies/policies/mp_pw_a05 3317.htm
OMG I AM SO FREAKIN' STOKED TO SHOVE THIS IN THEIR DENYING FACES!!
(Now I have Peggy Hill from King of the Hill in my head- all I can here is "WHEW YEAH!")
Tallia
This is from Empire BCBS/MN, from BCBS/MN OWN POLICY MANUAL as of February 2009!! If it's good enough for them, why not me?? (ok, so that probably doesnt sound right, but I usually don't make a whole lot of sense! LOL!)
It literally lays out for me why they should approve the surgery!!! 25 pages worth, right down to every sighted study backing it up!!
http://www.empireblue.com/medicalpolicies/policies/mp_pw_a05 3317.htm
OMG I AM SO FREAKIN' STOKED TO SHOVE THIS IN THEIR DENYING FACES!!
(Now I have Peggy Hill from King of the Hill in my head- all I can here is "WHEW YEAH!")
Tallia
Every opinion we share, every favor we perform, every moment we intently listen to someone talk about themselves is our opportunity to pass along something positive to a person who needs us.
I would almost call the letter-sender and ask them if this is a joke? The grammar and professionalism are completely lacking. I'd tell them that you are not taking this letter seriously and that you would like to speak with someone with authority and who is literate.
Started research @ 280 pounds
Surgery Date 05/27/09 @ 258 pounds
You know, that's actually a very good idea! I think I'll do that on Monday when they're open again! Thank you!!
Every opinion we share, every favor we perform, every moment we intently listen to someone talk about themselves is our opportunity to pass along something positive to a person who needs us.
I don't know how all the denial stuff works but...
I have one thing to add... breathe! You will catch more bees with honey then vinegar, that's what grandma always said. Don't P them off to bad ahead of the appeal, they will remember and that adds fire to their flame. Just an idea.
I have one thing to add... breathe! You will catch more bees with honey then vinegar, that's what grandma always said. Don't P them off to bad ahead of the appeal, they will remember and that adds fire to their flame. Just an idea.
Maintaining! Start weight 257,Current weight 122,Loss of 135# and 114 inches,Size 22-24W now size 4 to 0 (zero),Healthy life=Priceless
www.onetruemedia.com/shared
www.onetruemedia.com/shared
Thanks for that reminder- I'm just blowing steam here rather than at them! I work very hard at being methodical, logical and straightforward in life, esp in these matters! I have a huge binder stocked full of studies, my medical history, etc ready to roll should the need arise. I found out I can appeal to the board of trustees at my husbands union should BCBS deny me all around, and they have the ability to overturn the denial. I'm not going to give up! 
*** Wait a minute...? Does anyone else hear that...? Yes, yes, it IS the theme song from Rocky playing in the background! "We are strong now.. Won't be long now..."*** LOL!
*** Wait a minute...? Does anyone else hear that...? Yes, yes, it IS the theme song from Rocky playing in the background! "We are strong now.. Won't be long now..."*** LOL!
Every opinion we share, every favor we perform, every moment we intently listen to someone talk about themselves is our opportunity to pass along something positive to a person who needs us.
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