Won the War! Approved 1-12-06

Had many battles with two insurance companies. Finally switched to BCBS HMOI in OCt of 06. Another battle naturally. This time the problem was with the provider, the pcp and the medical director at a certain Chicago Hospital that denied my surgery. Reason: New patient, needs 6 month waiting period for pcp to get to know me. Sure.......... So Now I am placed in the hands of BCBS for an appeal level one. This was just about to be denied, when I hooked myself up with the administrator of the company hired by husbands employer who wrote the policy with BCBS. This denial was inexcusable. Waiting periods are not written anywhere in the policy. The hospital can not initiate their own set of guidelines legally unless it is agreed upon by all parties ( insurance, hospital, subscriber). I met all the criteria, and waiting periods cannot be placed on any HMO patients, Federal law. So this wonderful man went to bat for me with the higher ups at BCBS and got right to the gut of the problem. It took him 12 business days to solve this problem, and my denial was overturned and I am scheduled for surgery on February 3rd. If it wasn't for this wonderful man who beleived my story of "hoop jumping", I would still be jumping. Thank God I found him. Barb

OMG!!!!!!!!!!!!!!!! CONGRATULATIOMS!!!!!! I am SOOOOOOOOOOO glad to hear it!!! We emailed each other quite a bit during our fights in the middle of last year, and I have been watching closely for word of you. I too have changed insurance, I now have BCBS of IL PPO. I have not even applied for approval due to other health issues that have come up due to my weight. If the surgery had been approved last summer, these issues would probably have been avoided. As soon as I can get the doctors to clear me for pre-approval, I will try again. I will keep you in my thoughts for a un-eventful surgery and a speedy recovery. Thanks for the ray of hope, I surely need it! Dawn email me if you wish

Barb, I am so happy for you! You have been through so much, and really deserve it. I may have to do the same, so thanks for the ideas.