Hi all
1st thanks everyone for the support and all the helpful information in here. I started in here looking for a surgeon to perform a revision for me in IL- that has since changed.
INFO
- I am 5'6", 290lbs, BMI 46.8, insurance BCBS of IL, was 345lb in 2005 and had RNY, lost ~120lbs, for various reasons i am in continuous pain and have slowly gained to my current weight.
I decided that DS is the best option for my success. I chose Dr. Ayoola in TX to perform the revision. They sent off my to insurance and I have "not been approved"...
"Requested service(s) does/do not meet medical policy criteria/guidelines for coverage...
Deny 43659 (Lap Duodenal Switch) Medical Policy: Bariatric Surgery (SUR716.003) considers this service not medically necessary because your BMI is below 50. Also your medical records shows you had a gastric bypass in 2005, so this procedure would be considered a revision (re-do) surgery. This policy considers this service not medically necssary because you have not followed the prescribed nutritional program following the original (first) surgery.... EGD is showing technical failure.
Your physician may contact the Health Care Management Department to discuss this case with a physician adviser."
I contacted Dr Ayoola's office and they set up a meeting with this physician adviser this Friday. I was told there might be a chance that I could get the surgery, that its all up to the doctors on the call.
Besides gaining 20 lbs that would put my BMI to 50.... I want to provide additional information to Dr. Ayoola and/or BCBS to help my case. I have only spoken to Dr. Ayoola once. Right now I'm just a bunch of tests results to them.
I want to write a letter to Dr. Ayoola so he has more information about me and my weight experiences. Something that would help change the mind of the BCBS doctor. What should I write? What can I do? They factored in that there was a technical failure and still denied.
Have any of you succeeded in getting an approval after a denial from BCBS of IL with a revision from RNY to DS with Dr. Ayoola?
1st thanks everyone for the support and all the helpful information in here. I started in here looking for a surgeon to perform a revision for me in IL- that has since changed.
INFO
- I am 5'6", 290lbs, BMI 46.8, insurance BCBS of IL, was 345lb in 2005 and had RNY, lost ~120lbs, for various reasons i am in continuous pain and have slowly gained to my current weight.
I decided that DS is the best option for my success. I chose Dr. Ayoola in TX to perform the revision. They sent off my to insurance and I have "not been approved"...
"Requested service(s) does/do not meet medical policy criteria/guidelines for coverage...
Deny 43659 (Lap Duodenal Switch) Medical Policy: Bariatric Surgery (SUR716.003) considers this service not medically necessary because your BMI is below 50. Also your medical records shows you had a gastric bypass in 2005, so this procedure would be considered a revision (re-do) surgery. This policy considers this service not medically necssary because you have not followed the prescribed nutritional program following the original (first) surgery.... EGD is showing technical failure.
Your physician may contact the Health Care Management Department to discuss this case with a physician adviser."
I contacted Dr Ayoola's office and they set up a meeting with this physician adviser this Friday. I was told there might be a chance that I could get the surgery, that its all up to the doctors on the call.
Besides gaining 20 lbs that would put my BMI to 50.... I want to provide additional information to Dr. Ayoola and/or BCBS to help my case. I have only spoken to Dr. Ayoola once. Right now I'm just a bunch of tests results to them.
I want to write a letter to Dr. Ayoola so he has more information about me and my weight experiences. Something that would help change the mind of the BCBS doctor. What should I write? What can I do? They factored in that there was a technical failure and still denied.
Have any of you succeeded in getting an approval after a denial from BCBS of IL with a revision from RNY to DS with Dr. Ayoola?