BCBS....Good News, Bad News

[Guest guest]

I know a lot of you here are interested in BCBS approvals....I have

BCBS Vermont. I applied for prior approval for BPD/DS with Dr. Hess

two weeks ago, and......

It just came back approved, that's the " good news " .

The " bad news " is that they approved it at standard benefit levels,

which leaves me with a 30% co-pay and a $500 deductible, on top of

the $2500 that Hess asks for.

Their reasoning was that the procedure was available in network. It

isn't, believe me, I've looked. I suspect it's going to be the old

RNY argument, will know more shortly.

So now I have to convince them of the benefits of the " Long Limb RNY "

vs. the standard RNY.....this after I FRIGGING SPELLED IT OUT FOR

THEM, COMPLETE WITH DIAGRAMS in my original request.

Ahh, if it was easy, everyone would do it....

jj