BCBS of WV

Discussion in 'Insurance' started by Amvg74, Oct 2, 2018.

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    Amvg74

    Amvg74 New Member

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    Hi my name is Ash and I am looking for help with insurance. Basically I have gone to a dr who told me he didn’t want to do DS because he thought I wasn’t “compliant” with vitamins, which I know I can be. But that’s not the problem. I was going to see Dr Kershian I’m CA but apparently my insurance won’t cover out of network. They say “for Bariatric surgery they only cover CAMC drs (the hospital I work at) who does not do DS. Why would I go to a surgeon that doesn’t do DS? He only wants to revision. Is their any way I can fight this. I am 5’4 and 232lb. Help!
     
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    hilary1617

    hilary1617 First time at the rodeo.

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    Hi and welcome Amvg74Amvg74 ! There are ways to fight and it is well worth fighting for. Hopefully DianaCoxDianaCox and LarraLarra will chime in with suggestions. All the best!
     
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    DianaCox

    DianaCox Bad Cop

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    Ask your PCP for a referral to a DS surgeon. If you get denied, you can appeal. If there is nobody in network who does the DS, it may be possible to force your insurance to pay for an out-of-network referral.

    However, it's going to take some time - several months. Be prepared. But this is how you will live for the rest of your life - think twice, cut once.

    You will need to gather documents - your Evidence of Coverage - the full 100+ page contract, not the summary of benefits; documentation that the surgeon you saw doesn't do the DS and/or refused to help help you. You may also want to consider plans to do a consult with Dr. Keshishian to enable him to write a letter of medical necessity. You spoke of a revision - what surgery have you already had? And where do you live?

    There will be a lot more, but let's start there. Normally LarraLarra and I work together to help people with insurance appeals, but she is going to be unavailable for a couple of weeks.
     
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    Amvg74

    Amvg74 New Member

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    Well I saw Dr Abbas in Cleveland, OH and was looking into DS. I’ve done a lot of research on it. I have not seen Dr Shin (he is through CAMC in Charleston, WV) but I do know he doesn’t do DS. I live in Charleston, WV.
     

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