Yvonne
Well-Known Member
@Larra and @DianaCox
So I received more information on the DS approval with no mention of taking my band out. I received the approval last Friday in less than 24 hrs (Code 43845 - apparently the "bigger" DS procedure). I called on Friday, Monday, Tuesday and Wednesday I finally asked to speak to a person and not a voicemail. When the woman I was looking for got on the phone she clearly had laryngitis and that was why she had not called me back. That and she was having coughing fits the whole conversation. She did apologize and said she should have had someone else call me. They had not received the fax or the paper saying I was approved (I just received mine today).
She told me on Wednesday that she would have someone call BCBSIL and find out what happened. So the assistant in insurance called me back that day and said although they submitted in the letter to have my band out, it was not included in that code and they needed to resubmit. They resubmitted it on Thursday and today I got the news that it was DENIED!! They will pay $28,000 for the DS but not pay to remove my crap band.
For some reason they resubmitted these codes
43774 - Lapband removal
43775 - Laparoscopic sleeve gastrectomy
43659 - Laparoscopic miscellaneous procedure of the stomach
That is the EXACT codes my EX-surgeon used that was denied TWICE. In fact they told me that today. They did not tell me why it was denied. I forgot to ask. I am at a total loss. I am sick and tired. I don't know why they won't take care of me. I don't understand this at all. I'm beginning to wonder if there is hope of me having it at all. My husband said he doesn't think it's going to happen, because he's the pessimist in the house.
So I received more information on the DS approval with no mention of taking my band out. I received the approval last Friday in less than 24 hrs (Code 43845 - apparently the "bigger" DS procedure). I called on Friday, Monday, Tuesday and Wednesday I finally asked to speak to a person and not a voicemail. When the woman I was looking for got on the phone she clearly had laryngitis and that was why she had not called me back. That and she was having coughing fits the whole conversation. She did apologize and said she should have had someone else call me. They had not received the fax or the paper saying I was approved (I just received mine today).
She told me on Wednesday that she would have someone call BCBSIL and find out what happened. So the assistant in insurance called me back that day and said although they submitted in the letter to have my band out, it was not included in that code and they needed to resubmit. They resubmitted it on Thursday and today I got the news that it was DENIED!! They will pay $28,000 for the DS but not pay to remove my crap band.
For some reason they resubmitted these codes
43774 - Lapband removal
43775 - Laparoscopic sleeve gastrectomy
43659 - Laparoscopic miscellaneous procedure of the stomach
That is the EXACT codes my EX-surgeon used that was denied TWICE. In fact they told me that today. They did not tell me why it was denied. I forgot to ask. I am at a total loss. I am sick and tired. I don't know why they won't take care of me. I don't understand this at all. I'm beginning to wonder if there is hope of me having it at all. My husband said he doesn't think it's going to happen, because he's the pessimist in the house.