Just venting

I just wanted to post about BCBS. Whether you have BCBSofDE or BCBSorIL...they are not all the same. They all have specifics to meet. I have found that out the hard way. To those of you who seen to think that its a done deal just because its BCBS your wrong. I am still fighting and if I don't get anywhere here I am going through another Dr in New York that will fight the insurance company with everything he has and has proven it. I really feel right now that Dr Irgaus office is not pulling for me! I could be wrong but thats how I feel. If I didn't meet all of the criteria that was needed than why wasn't told that before I even had a date! Misty said that my insurance was tough so does that mean shes not going to help me. I read everyones profiles and see the some of the troubles and how she went to all kinds of lengths to help. I don't see that here. I'd like to know why my records from PMRI was not sent to my insurance. They needed that info too and that was one of the reasons for denial. Not willing to comply with pre-op and post-op care. I paid the $1200, went to the classes, passed, saw the nutrionist, the psycologist and all. And all that was not sent! I'm sorry for venting like this but I have lots on my mind and this seems to help. I have been a disaster this weekend. I haven't been able to do anything but sleep. My poor husband doesn't know what is wrong with me and i just tell him that I don't feel good. This is so upseting. And I have not heard anything from Misty at all today about any of this or what I should do now. That doesn't help much. Thanks for listening Sharon B

I'm sorry, I assumed that one BCBS would be the same (if not then very similar) as another, just managed out of different states. Keep calling, ask if you could get a copy of your file so you can fax it yourself (for peace of mind). Call your insurance and ask who your caseworker is and talk to them personally. Get their direct fax number and fax the files yourself. Call Misty every day if you have to. Yeah, you will be a PITA, but hey, the squeakey wheel gets the grease! I left a message for Misty that basically said that if I got denied because of getting my paperwork in late, I was going Postal on them! write a letter to the insurance company. I think several of the members here posted their letters on their websites. Take a look. Good luck. Dee

Hi Sharon: Sorry to hear about the problems your having. I just wanted to share this with you. I went to the PMRI meeting last night in which Dr. Wynn spoke. The program coordinator was there and people were talking to her about similar problems with insurance. Her name was Michelle. Try calling her and see if she can give you any advice. Kim S

Thanks Kim....I am going to call PMRI today. I am ok with waiting 5 more months...that would be how much longer at supervised diets since i've been doing this since april. I'm just worried about a new policy year in 06. I have lots of questions but misty hasn't returned my calls. I don't want to go thru PMRI for weight checks. It's way to far for me to travel at $3.00 a gallon for gas. I live in townsend, de. I am just gonna go thru my primary and have him monitor me. Anyway, I could go on and on...thanks for the advise. Sharon B

Having your PCP monitor your weight loss should be sufficient. Double check with BCBS & see if there is someone they might recommend that you see (a specialist or something). I'm glad that you only have to wait 5 months instead of 12. I'm wondering that since you originally applied for the surgery this year, that their policies are locked in on this particular case. Meaning that even if they change ther policy in 06 for WLS, because you applied in 05 and were doing what their program required for approval, that they would have to approve you if you met all of the conditions they stipulated to you for this surgery in 05. Keep copies of EVERYTHING you send and receive from your insurer. Make sure everything is dated! Please keep the lines of communication open with CHRIAS. With all of the new Dr. in the office, I'm sure her workoad has increased dramatically Hopefully this will be the only bump you have in the road. All of us have experienced this kind of stress at one time or another. Good luck.

I would recommend getting your policy faxed also. I attempted to have the lap band done last February. I too, had paid and met with all of the necessary doctors and was denied. It was considered to be experimental through BC/BS of DE at that time. Then in August, something just motivated me and I called the insurance company myself. I was told that it is now being covered. Be a PITA to your insurance company, that is what I did. Sometimes, insurance companies work better with us than with Misty. Hang in there, don't get down, just be persistent! Good luck.