DISALLOWED

DISALLOWED Pulled up the BC/BS web site last night after a all day marathon of Doctor apt. for WLS and some eye  apt. for Debbie. Saw the mesg. A Pre-Authorization request for a Surgical procedure is DISALLOWED!  Boy that will make you blue!! But then you get mad (note the red Ha Ha). Then as Debbie points out  just another hurdle, so you get determined. Wasn't going to write in the forum just deal with it. But as so many have pointed out if you don't share the good, bad and the ugly it paints a unfair picture to others. But DISALLOWED such a ugly word to see.. It's OK if the say peeing in the pool is DISALLOWED or FOOD and Drink are DISALLOWED But not surgery!!!! Just trying to keep it lite hearted. Bob

That stinks Bob. You've worked too hard and come too far for that. I'm sure there are folks here and on the Men's Forum that can give you info on how to get this overturned and get approval. Get all the ammo you can together and file an appeal. Don't give up!

That sucks.  Did they give you any reason for the determination?

Bob I'm still swimming in that BC/BS pool of "stuff" trying not to drown ......hang in there brother, WE WILL WIN!!!!!!! WENDY

Spoke with BC/BS they sent Vandy a letter, it had to do with a weight variation of 100 lbs? Not really clear as to what that meant maybe simply a typo on Vandy's part. Spoke with Vandy they were checking it out and getting back with me. I'm hoping its that simple, but if not I'll just roll up my sleeves and keep fighting. Thanks BamaBob, Kathy, and Wendy for your support.

Hi Bob:   What a bummer!  I know all insurance is different, and I have Cigna.  I was supposed to have an answer last Friday, but they put it off until noon today.  I am home with the flu crud and I'm almost afraid to call to find out the answer. Keep us posted, and know we're all cheering for you! Jane O

 Well found the idiot who screwed up the paperwork!!!!! It wasn't Vandy and it wasn't BC/BS. Three guesses anyone??? Yea it was me. 65 pages of info submitted and on one when I was transcribing it to the computer I made a typo instead of 266 lbs I put 166 lbs. Even though all the other documents established the correct 266 lb. number, someone caught this. So I spoke with a sympathetic women at BC/BS who gave me a direct fax; # to the claim officer working on my case. Faxed the corrected paperwork and a letter begging pleading and yes KISSING some #$%. So let see what happens now. Thanks to all. Bob

You'd think they would look at all the other listings of your correct weight and figure out for themselves that this was a simple typo. Sheesh! Looks like they were just looking for something to use to delay the process.  Glad you found the error and someone helpful at BCBS to assist in getting the correct info into the system. Here's hoping and praying they will approve you now with no more problems. Hang in there!

Bob, I am very sorry to hear about your set back.  But it is just that, a set back.  Like a lot of people have said already, most of us have been there and we know your pain.  Some of us have been there 2 or 3 times and we bought the T-Shirt too.   Will telling you this make you feel better? Probably not.  But I hope that it does encourage you to keep up the fight and keep going. It won't be long now.  You are in the BC system and you were even given a direct fax #, that is cool.  So now just prepare yourself when you make another phone call to check on your status and they tell you "Yes" Mr. Bob, you have been approved, you will feel like you are having a mild stroke before you can say thank you for your help and hang up....LOL You are doing an awesome job... I just wanted you to know that.....

Thanks Trina, Even with this set back look how much farther along I'm thanks to you. If I had sat back and let things roll I would have been weeks behind. Just a thing! Thanks C' Ya Bob