Question:
I have been denied by BCBC and was told there is nothing else to do. Can someone

tell me the qualifications in Pa or help me to find out how to do this?    — Virginia K. (posted on August 6, 2004)

August 6, 2004
What was the reason for denial? Do you have a copy of your policy, it should have it written in there what your specific plans policies are. It doesn't matter what criteria another person has to meet, it depends on your own policy. Is there an exclusion? If so, you could appeal to your employer to have this exclusion lifted and to add WLS as a covered benefit. If it is in fact an exclusion, then other than the employer ok'ing the procedure, and allowing it, then there isn't much you can do. The insurance company isn't going to allow a procedure that they aren't being paid to cover. Have you looked into self-pay options or other insurance plans? Good luck- Shannon
   — M. Me

August 6, 2004
Denied as in ALL your appeals? BCBS ususally - as the 'final' say is an outside review board... did your appeals go THAT far? if you were turned down there.. then yes.. BUT if you were just 'turned' down by BCBS... You have appeal rights.. Check your 'insurance' handbook for EXCATLY what you can do and the time frame.
   — star .

August 6, 2004
I read your profile and it says that you do not have the documentation from your PCP. Get your diet documentation and if it is a covered benefit then you probably will be able to have WLS if it is a covered benefit.
   — ChristineB

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