Denial Letter - Blue Cross of CA

[depperly]

Hi All. I am new to the group - and just getting ready to have my lap band done. All the pre-op work is done - and then I receive a letter of denial from Blue Cross of California. I am preparing to write an appeal letter. Just curious if anyone else has written an appeal and been succesful. If so - what did you base the appeal on? Mine was denied because my BMI was too high. They said that for anyone with a BMI over 50 - it was deemed "investigational and not medically necessary".

If anyone has any info - articles - anything that would support my appeal - I would be most appreciative.

[Kathy]

Oh, dep, you should for SURE contact Inamed. They can send you an entire packet, I hear, with documentation to send in with your appeal letter. I'm sure you'll get more feedback here, but if you want a band and not another WLS, hold out. You might have to fight harder or lose a bit of wieght first (even though you shouldn't but you might) but you can get that band! :)

[PhotoNut]

Hi Depperly, welcome to b2g. So sorry to hear about the road block you just encountered. I've known others who were met with similar surprises after the pre-testing was done. I'm sure they'll tell you their stories and how they handled it. Some stuck it out and fought until they won, while others decided they didn't want to wait and chose other options such as the RnY surgery or going to Mexico for the band.

I was self pay, so I dont have any suggestions for you, but I just wanted to welcome you and encourage you to hang in there. Appeals are being won and there are many who will be happy to help you in that process.

*hugs*

[depperly]

Thanks Kathy and Susan. I appreciate the support. I intend to fight this - and win. I believe this is the right thing to do. I'll let you know what happens!

[Kathy]

Thanks Kathy and Susan. I appreciate the support. I intend to fight this - and win. I believe this is the right thing to do. I'll let you know what happens!

You go, girl! :boxing: Keep us posted.

[Kim G]

Hey there...keep fighting. I know 2 people on here one fighting and one faught and won. Mrs Sabre...won and Judybellieband is fighting....different reasons but maybe they will chime in and help you out some.

GOOD LUCK and remeber I will do what I can do to help!!!!

[PhotoNut]

Chisaimama fought Blue Cross of Idaho and won. Now THAT is an accomplishment! I know she had the attorney from Inamed helping her. I'll point her to this thread so she can give you some info on how to get help with your appeal.

[JudyBellyBand]

Hi Dep . . I know and understand your anger, disappointment and resolve to fight this denial. My condition is a little different but perhaps you can find some central or core ideas that apply from my letters as I did from Mrs Sabre. :eyebrows: These letters are available to you by reading 'my journal' here on b2g. Please keep us posted on how you are doing. It is a very difficult and long road to battle them . . they use the wait card. So be ready and join me in "the fight".

[Mrs Sabre]

Doug,

You have the letter I used. Although it may not address the specific reasons for your denial, maybe the general format will prove useful? It took my insurance less time to overturn their denial (< 2 weeks) then it took for them to issue it (> 4 weeks).

God bless, good luck, and keep fighting!

[dynamomini]

Hi!
So sorry to hear about your denial. It is interesting that BC/BS Anthem of Colorado categorically will not even look at WLS. Or at least that is the info I have. I think it is bizarre how some BC/BS are covering and others aren't. Is this legal?

[depperly]

Thanks all for the response and the support. The appeal letter has been mailed today. Keep your fingers crossed - and say a prayer.

Doug

[Chisaimama]

You might contact walter Lindstrom at obesitylaw.com. He and his wife do help with people having trouble with insurance companies. I don't know the cost because Inamed paid for them to appeal for me in Idaho. They are really great to work with.

walter@obesitylaw.com