Denied by Wellmark BCBS

HelenH48

New Member
Joined
Oct 17, 2017
Messages
1
Hello, I started my VSG journey 02/2017. I completed everything required for my plan, paperwork was submitted on 09/01/2017 and according to my denial letter, which states "Not Medically Necessary , due to lack of medically supervised weight loss attempts" , in which I took supporting documents to my surgeons office, prior to them submitting request for approval, they denied the request on 09/01/2017 and I received the letter dated 09/12/2017 . My surgeons office says that they will file an appeals , but as of yet none have been filed. When I call the surgeons office and ask to speak to the insurance coordinator, I' m told that she is unavailable and she will call me back in 2 to 3 business days. When , if she calls me back, she has a serious attitude and says," she has forward all the paperwork," including other paperwork that I have taken to the office ,"to the surgeon, and there is nothing more she can do. I guess reaching out to him is beyond her means? What exactly is your job description? I so aggravated. First, my original surgeon, left the practice in 07/2017, so they added me to the new surgeon, and now I feel that they don't care about my appeal , because he have other patients who got their approval and I'm placed on the back burner. Help, what to do!!! I" m trying to get this done, by 2018, because my deductible has been met , and out of pocket costs will be cheaper .My care manager at Wellmark thinks I should file an appeal myself ,or seek help from another surgeon. Another surgeon is not an option , because it's a process trying to get into a program here in the Charlotte area and I feel they will drag their feet about releasing the paperwork in a timely fashion. I'm so lost I have no clue, how to write a good appeal letter, any help would be greatly appreciated. Thanks
 
Another surgeon is not an option , because it's a process trying to get into a program here in the Charlotte area and I feel they will drag their feet about releasing the paperwork in a timely fashion. I'm so lost I have no clue, how to write a good appeal letter, any help would be greatly appreciated. Thanks
Another surgeon is always an option. All you have to do tho is to go to the office and wait for either proof of being faxed or til they hand it to you to hand carry. Be assertive.

Is Wellmark BCBS an ACA plan? How do they define "previous weight loss attempts"? Is a visit to a bariatric surgeon or a PCP necessary on the same day of each month (taking weekends into account) for a certain number of months, documenting your weight and discussing how to lose?
 

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