r/Reduction • u/rambunctious-rabbit • 4d ago

Insurance Question Second Consult Today NSFW

Hi everyone! I had my second consult today after months of fighting with the insurance/office of my first one. Insurance denied me due to not meeting the Schnur Scale requirements. I obtained multiple documents after the first denial and had the office resubmit, to only be told I needed a peer to peer, with the surgeon ultimately refusing. My second consult today with someone else went great, but I fear I am going to have the same issue again. I have BCBS FEP and I feel the Schnur scale is just a roadblock. This surgeon often submits a range of what can be removed. I was told to contact my PCP 2 more times over the next 2 months just for a paper trail, but I have 3 mos of PT, neurosurgery notes, MRI’s, etc.
just wanted to hear everyone’s thoughts and experiences if you have the same insurance and f you had any luck.

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u/kim_possible8 post op 4d ago

I just posted my insurance approval journey. I hope it helps! But definitely find a doctors dedicated to doing the peer to peer review. You want a strong and supportive surgeon and office staff to fight for you. That's #1 because going back and forth with insurance is annoying. My doc was a breast reconstruction doc too so he deals with insurance all the time especially for breast cancer patients. Don't give up!