Denied by BCBS-they want a peer to peer review

Deirdre1472
on 8/10/16 3:18 pm

I have a long story about the tortureous lap band that I need removed and revised to RNY.

BCBS denied me today but is requiring a peer to peer review. They didn't tell the doctors office why I was denied but they wanted a peer to peer review. My doctor's advocate said this could be a good or bad thing. I haven't had a lot of test done just the barium swallow that showed how tight the band is. I've had terrible reflux, dysphasia, aspiration, and port pain.

For those who have had a peer to peer review what was your experience?

(deactivated member)
on 8/10/16 7:44 pm

It will be denied again and then approved the 3rd time. It will take about 6 to 8 weeks. The insurance doesn't want to pay, but they don't want to be sued even more, so after the 2nd doctor request they start to fear the lawsuit more than paying for your surgery.

And yes, I've been there.

 

Deirdre1472
on 8/10/16 8:56 pm

So I need to be prepared for a month and a half fight?  I'm willing to do that. I mostly want this lap band out. This thing was created by Satan himself. 

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