Connecticare Insurance vs Blue Shield

Hi everyone, First of all HAPPY NEW YEAR. I hope that all is well with you and yours and that this year is a good one for all of us. Hoping to pick the collective brains here. BS Shied denied my surgery, even with a letter from my doctors specifically outlining my 6 month weigh ins, and his statement of counseling me on proper nutrition and exercise. At this point my surgery date has come and gone, and even though I have gotten my PCPs involvement and wrote the letter and he signed on it, BS is still being horrific. I will have an opportunity in April to enroll in ConnectiCare as opposed to BS and wondered if anyone had any thoughts they would like to share. Thanks, NA

What reason did BCBS give for the denial? Are you looking for Lap Band or RNY? I know that a lot of BCBS in CT is denying all surgeries after January 1st..and some are excluding it as their open enrollment periods come up. A lot of us rushed to get apprived for 2005 surgeries before Jan. 1 for thsi reason. The BCBS are making it harder to get WLS even if they are not stopping it outright. It depends on your contract and company and what it negotiates for its members. Check with Connecticare and ask them for their policy on WLS. Then you won't have to speculate. I heard so many stories on here it was making me crazy....I finally just took the bull by the horns and called. I have heard that Connecticare was good in the past...but then..so was BCBS....You have ANthem? Do you have BCBS..or just BS? All these little things make a big difference as each company or subsidiary has its own rules... Good Luck! Sher'

I would definately go with Connecticare. Everyone I know who has had the surgery had Connecticare with no problems. My employer no longer offers Connecticare so I went with Empire Blue Cross Blue Shield. I was just denied today for lack of 6 month medically supervised diet. Do you have Empire bc/bs? Did your doctor appeal for you? who is your doc? was your denial for lack of 6 month medically supervised diet? Thanks, Joanne

I was denied for lack of 6 months medically supervised diet and nutrition. But the thing is that my physician had me come in for monthly weigh ins for 6 months, not including the two months I had to be seen by my surgeon's nutritionist for counseling and to be sure I could make weight. My doctor sent the insurance company, Highmark Blue Shield (out of PA), a letter with the weigh ins and a statement to the fact that I would be a good patient and that I have been counseled by him on nutrition and the fact that I am not gaining and managed a couple of pounds down shows that I am an excellent candidate. My PCP sent this letter to the insurance company, at their request, and it was supposed to be for additional information only. The b*st*rds used his "additional" information letter as an actual appeal. The surgeon who sent the information did not even get an appeal. I am screaming at the insurance company on this matter, but they are being jerks. Right now I am planning on getting all of my records from the surgeon's office and going over them thoroughly as with my particular policy I only have one member appeal available to me. As sad as that may seem. Otherwise I would have to go to an external appeal, and that is simply not within my means financially. Finally my surgeon is Dr. Barba, from St. Francis. Thanks for your words I am going to check into Connecticare as see what their requirements are. I am presently waiting on a packet of their current information for our current plan and will compare that to what I have. It is just frustrating as I have had all of my consults, which the insurance company didn't bad an eye at paying, and have been approved since July. Met the surgeon in October and had a date that will be gone in a few days. It is just horrid that they make you jump through all these hoops and still turn around and deny you. In fact with 22 pages of information they denied me in less than 6 hours the first time around. Think they never even read the stuff. AARRGGHH!!! Thanks for listening to my frustration, and Joanne, hang in there, since you are in the same boat as I am. I will keep you in my thoughts. NA

NA, I had surgery 9-21-04 with CT-care and they approved on the 1st try and I had no problems at all with them. Terri