Revision Denied

"Insufficient evidence of serial nutritional compliance."

That's their reason.  They might as well have written "We are looking for a bullshit answer to tell you no."

I hardly ever get mad.  But right now, I'm PISSED.

My PA actually thinks this is great news though.  She thinks it's a small victory.  They didn't mention my BMI being too low, or having no comorbidities, and since it was not mentioned, they cannot change the reason later.  She thinks this is easy to dispute, because if I wasn't complying with the nutritional guidelines, I wouldn't have lost weight.  No one loses 110 pounds by eating cake, ice cream, and chips.  We all know this right... apparently BlueCross BlueShield of NC doesn't realize....

They will submit an appeal today with documentation of nutritional visits from the past as well as another letter from my PA documenting my typical eating habits.  If there is no news, my doctor will personally set up a peer to peer review, where the insurance company will have to send a representative to meet with my surgeon for an appeal meeting.

I hope my PA is right that this was actually good news.  It definitely does not currently feel good.

Comments

  1. BandedIceGirlJune 3, 2014 at 1:16 PM

    awww that sucks, I hope that your PA is right and that you will get approval soon.

    ReplyDelete
  2. Tina@The BanditGirlJune 3, 2014 at 1:25 PM

    Hang in there! They are probably just hoping you would quit. So glad your surgeon's office is playing such an active role on your behalf. Good luck and chin-up, girl!

    ReplyDelete
  3. ColleenJune 4, 2014 at 9:20 AM

    soory you were denied. I hear that happens a lot though, so it's nothing about you, that's just what insurance companies do. You got your PA on your side, so i'm sure your appeal with be sucessful.

    ReplyDelete
  4. SheilaJune 10, 2014 at 9:29 AM

    Well, I'm with you, GLAD they think this is GOOD because it sure seems like a slap in the face. Ugh. I hope everything goes well, and you are doing all the right steps...hang in there!

    ReplyDelete

Post a Comment

Popular posts from this blog

Life ....or Something Like it

 There was once a time that my blog was therapy to me.  It seems now I neglect my blog for actual therapy- but that is probably a good thing.  It has been 2 years since I wrote a post.  It isn't for lack of wanting to, I just don't want to be fake on here, and there were times that I felt like I could not be transparent or myself, so I chose not to write.  It was nothing to do with weight loss/gain- I will always be transparent there, but my life was a little upside down and sideways at times over the last few years.  I am finally at a place that I can be me, so here I am again. Being me isn't all pretty- but it's honest. The last two years have been...busy. I had my skin removal surgery on January 27, 2022.  I'm almost 19 months post-op, and it was hell!  The surgery itself went great: -Lower Body Lift with Belt Lipectomy -Breast Lift with Augmentation The healing process was the hardest.  I didn't feel like "myself" for about 6 months and that is som
Read more

Ten Things Thursday

Image
1. I forgot to weigh in this morning, but my other weigh ins this week tell me the number on the scale really had not moved since last week. 2.  Yesterday my plans were kind of up in the air.  First, my mom talked about coming to visit.  Then Mr. Banker asked to come over.  Then a friend, Ashley, asked me to go to dinner.  My mom canceled, so I told Mr. Banker that Ashley had asked me to dinner, so he told me to go out with her.  I guess he wasn't expecting I would be at the restaurant for 4 hours because apparently he was planning to come over after my dinner. 3.  One of my favorite things about Lap Band is that I can usually go out to dinner for about $4 now.  If you don't have a card from your WLS that states you can eat from the kid's menu, you're missing out! 4.  I need a fill.  I'm hungry all the time right now.  I tried to move my appointment up, but they didn't have any openings.  I'm so thankful my PA will be back next month!  It's so much
Read more

32 Weeks Pregnant

Image
Hi everyone, just wanted to stop in with a quick pregnancy/weight update. So... I'm still lighter than I was the day I found out I was pregnant, but I have watched the scale creep up slightly and that is hard!  SO HARD! Above is a picture I took Friday at 32 weeks.  It's insane, I hardly even look pregnant at all.  7.5 weeks left, hopefully I can stay under my pre-pregnancy weight in the next 7.5 weeks!
Read more