Appeals package submitted

[Guest guest]

Well I overnighted my appeals package to BC/BS of SC yesterday.

Included in the package was Dr. R's appeal letter, a letter from my

PCP and my letter. I spoke with Debbie Cleeland, the supervisor in

the Medical Services Department at BC/BS regarding my initial pre-

cert request. She said that they are not so opposed to the surgery

(gastric by-pass) as they are the potential and often occurring

risks. I asked her whether or not she had read all of the

documentation I sent in describing the surgery and the risks. I asked

whether she had read the abouth the existing co-morbidities I have.

She admitted to me that she had not. I chose not to debate this

verbally with her. A decision was made on the CPT coding alone. I

appealled the decision right away. So I guess the waiting game has

begun. I have already made an appointment with an attorney. He is a

friend of mine and he is interested in the MGB for himself and he has

BC/BS. That is set for next thursday. It still galls me though that

we pay these insurance companies for health care services and then

let them dictate what they will treat and cover and what they will

exclude based solely on a number/code.

Thanks for being here everyone. This is a good place to come and

vent.

A-J

Impatiently waiting to do the " dance "