Question:
I was just denied so I'd like to pass on a little advice.

I was just denied WLS surgery as medically unnecessary, even though my doctor recommended me for it. Things that I think you can do to improve your chances with BCN are: 1) Ask to see your physicians letter or referral. Make sure it emphatically states, in no uncertain terms, that the surgery is medically necessary. Our PCP's can list all the co-morbidities and lead them down the path, but make sure they make the exact, precise statement. THIS BARIATRIC SURGERY IS MEDICALLY NECESSARY". Ask your doctor if you can mail it with all the other information you are going to send. If not, take your information to your PCP and have them mail it with theirs. MAKE SURE IT ALL GOES IN ONE PACKET! Registered mail is preferrable. If they lose it, as they are prone to, you'll have proof they received it. As a precaution, copy everything you are going to send. When they lose it, its so much easer to recompile and resend. 2)Blue Care Network requires a psychological evaluation as part of the process. Get an in plan psychologist if you want BCN to ultimately pay for it. You could pay for one out of pocket to move things along as the in plan shrinks are typically booked out 8 to 12 weeks. I paid out of pocket and got it done in one week. You'll need the MMPI (Minnesota Mutiphasic Personality Inventory)exam done with the shrink. The shrink will send it to your PCP. Make sure this gets included with your initial submittal. While I was out getting my psychological evaluation, and paying for it out of pocket, they were denying me. Was it wrong to deny me before they received the evaluation? Yes. Was it a mistake? Possibly. But now, I have to appeal to find out. Don't take the chance. Submit it up front. 3. Include a personal letter of cause. Tell them how it affects you personally. Send them a picture. Let them know there is a thinking, feeling, breathing, hurting person. Make them see as you something more than a claim number. 4. Wait a week after submittal, then call them. Did they get it? Do they need any additional information? Try to get a specific name of the person or persons reviewing your information. I'm not sure this is even possible, but if I had it to do over again, I would try. You need to find someone in their organization to hold responsible. Call every other day and check the status. Are you being a pain in the ass? You bet. But they'll remember you. Every call you make is logged. I'm not sure if any of this will ultimately help, but this is what I would try if I had it to do over again. People have been approved with BCN. I don't know who it was, or what the co-morbidities were, but I was still denied. The best defense is a stong offense. Go get 'em...    — Ken G. (posted on July 14, 2000)

July 14, 2000
Thanks for the great advice Ken!! Sorry you are having such a hard time. I am in the pre-op testing phase and having a hard time getting info from my insurance co. - they keep saying call your pcp - pcp says call surgeon - surgeon says call ins. and so on and so forth. I'll definitely try some of your suggestions. BTW Keep your chin up - It seems to me that at least 50% of the people on this sight have been denied before they were approved. Best Wishes!
   — Becky H.