Please help with any helpful advice about BC/BS of Florida

Hello, I am becoming vey frustrated with the approval process in dealing with BC/BS. My Doctor wants me to get a letter from my primary physician to indicate that this WLS is medically needed. My Doctor has pretty much wrote a 3 line statement " Stating that I am under his care for a few medical issues and that he feels that having this WLS will probably decrease my weight related health problems". I have done all I know to do except go into my doctors office "push everyone aside and type the letter myself and demand my doctor sign it" My WLS doctor insurance liason has called them and told them what BC/BS is requiring for this to be approved. You would think they would listen since my doctor does this everyday right. Well today after almost 1 month of trying to get a letter faxed backed to my WLS doctor they have faxed over the same letter from 3 weeks ago. To no avail. I am about to pull my hair out if not every nurse in the doctors office. Is this letter really necessary to get approved???? I have done all this testing and I can see myself on the other side but at times it is so depressing to get to the mountain , begin to climb it get all the way to the top anticipate going down the other side to look up and see all the bolders coming down at me trying to knock me down. I won't give up ....... but it is frustrating I have been working on this since August-September. Can anyone offer me any advice to assist me in this ordeal. Signed: Very Frustrated but not a quitter...

My PCP kept sending me a weak letter, filled with grammar and spelling errors. I called one day and asked him, since he had "such an incredibly busy schedule," if it would be okay for me to "draft" a letter and even email the template to his office. He said okay!! and the letter he submitted was all mine, virtually verbatim!! Don't give up, I know it is frustrating. Take a look at my profile and you'll see that I know what you are going through!! Kristen

I also drafted a letter and faxed to his office. He still did not write a letter for me. So when I went to his office, I saw his Nurse Practicer and she wrote me a letter. Sometimes we just have to push and push some more. My doctor did not want to write the letter, as I was not using the surgeon "he" wanted me to use, his buddy. Too bad! I got the letter anyhow!! Over look all the miss-spelled words...

You might want to call and talk to the doctor yourself. He might not realize the letter is weak. He could have someone else written it for his signature. Ask him if you can write one and send it to him for his signature or make an appt and take the letter to him. Do not give up. I found out my problem was his staff, nit him. I threatened to go in and copy my file myself.

My surgeon had given me an outline of what he needed in my PCPs letter. It was a bullet point list like: -- Years MO -- Medications taken -- Medical issues etc. etc. I gave that list to my PCP and he made sure he touched on all of those points. Offering to type it and send a template is an excellent idea, it saves his office staff time. I had some problems getting the letter from my PCP and getting copies of my medical records. I love my PCP and wouldn't change for the world so I didn't want to ruin a good relationship. I showed up early at the office one day and offered to make my own copies, do my own typing, etc. The turned down the offer, but within an hour I had everything I needed. Good luck, I know it's frustrating, but hang in there!

I am new on this web sit, but I also have BC/BS and had several problems with my doctor not writting the correct letter. I had my surgeons office call and fax over a detail list of what needed to be in the letter. It took about 4 weeks of constant calling and the surgeons office calling before the letter was sent. Hang in!!!! It will happen. Margaret

I want to first thank everyone of you *****plied to my urgent need to vent. If I wasn't a BBW that I am. If I was a smaller size I believe I would of just jumped over the wall and through that little glass window that seperates patients from the medical staff. We all know what I am talking about. I have drafted a letter of what needs to be said, given it to the nurse. It is currently in my file at the doctors office NOW. The nurse who does these letters has informed me to my face " why won't blue cross /blue shield accept the letter that was typed earlier 3 weeks ago.That she shouldn't have to type this lengthy letter. I explained her the process of what it takes to get approved and she just sat there and stared at me. I was near tears. She then went on to say well Gerilynne you know you have high blood pressure so don't get so upset. I have been throught this whole ordeal for over a month with this doctors office. I am so frustrated that you may all see me on channel 2,4, 7 what ever station news protesting. I informed her that you can submit to BC/BS when it comes for bills to paid and call me at home and ask me to stop by to fill out this form or that form but now that I need my doctors assistance. The staff can't put a finger to a typewriter or computer to print out what needs to be done for their patients. Never mind i had to pay a co-payment just to get a letter drafted and I still didn't get that done. Thanks for all your concern, i am seriously considering calling the AMA and filing a complaint. Geri

Gerilynne, I feel your frustrations. I too started my approval process the same time as you. I have BCBS of Alabama and they are making me jump through the hoops for the approval. Their first letter back to my WLS doctor stated they needed documentation of weight loss attempt in the past 12 months. My gynecologist wrote a letter stating my attempt and all my weights since June last year to show my weight lost, gain, lost, gain, etc. and BCBS came back with a second letter stating they had not received documentation on non-surgical weight loss attempts specifically within the past 12 months. I called them and the nice lady at BCBS said they wanted specifically what I had done to attempt to lose weight. I told her on my own I tried Atkins and asked if my dr. wrote a second letter documenting I tried low-carb Atkins that is all they needed and she said "Yes." So I wrote a letter to my gyn, basically pleading with her to write a second letter documentating what I had actually done and asking for her help one last time in the approval process. Her office is writing a letter but she is not happy that BCBS did not accept her first letter and neither am I. I did type a letter myself for her office to use a guideline and faxed it to them. Hopefully her letter will sufice BCBS. My advice is to write a letter and walk it into you PCP office or make an appt with the dr. And you may want to have him include the things I needed just in case. I know our insurance is from different states but it is still BCBS! I also am -- Very Frustrated but not a quitter either. Good Luck! Tammy Wolford

Tammy, Thank you for your advice. Tammy I drafted a letter and brought it with me to my doctors appointment. My doctor asked me to take the time to write down all the attempts that I have made w/ my weight loss/ gain.I did it in the room waiting so I left he told me it would be ready on monday. I called the office this pass Monday and was told that it was ready. I went there to pick up my copy to keep it in my file. Thank god I read it before driving off. It was the same letter that I all ready told them was not sufficeint for BC/BS. She wants me to have BC/BS to call her & tell her what they want from her. I guess she feels that BC/BS will take the time to call her and ask her advice about me. I have never saw this lady before in my life. I will not give up on this battle. I just keep the saying " good things come to those who weight" Geri