Bluegrass Family Health Ins.

Lately, I've been reading some negative comments about Bluegrass Family Health. I had to self pay(I had to have this surgery this summer due to many reasons). I had surgery July 3, 2003. My BMI was 64. (I have my fair share of co-morbidities to be just 21 yrs. And my family health history is of concern to my pcp). Bluegrass would not accept "the way" my pcp documented my dieting (6mo.), so I was denied. I think this stinks. Afterall, I met the medical criteria. I have at least 200 lbs. to lose. What will 6 more months of dieting prove? I think this is a delay tactic. They don't think people will appeal. I also think this decision could be considered medically negligent since they are asking a super-morbidly obese person to try a treatment that has been proven not to work (more dieting), in place of a treatment that has been proven to work (surgery). I lost my first appeal. I'm going to try Walter Lindstrom, or maybe a local lawyer. I hope I can get some reimbursement. If not, it is money well spent. I think eventually Bluegrass will no longer pay for this surgery. I would be interested in hearing from others who have had problems with this ins. co. & any legal suggestions anyone can offer.

I suggest you contact your case worker directly. Ask every question possible and I mean every thing you can think of. Do not report you lose a single pound and make sure you don't weigh in a doc office for it to be documented. THey can come back and say you lost this way without surgery just be very careful. PLEAAAAAAASE stay with it. Prove to them you might not have six more months.. Your PCP could also contact or write a letter to this insurance company. One more thing --- I live in Bowling Green KY and as of last week or local health department medical card covered this surgery for a young women needing to lose 200 lbs. You might try that as well. Thank You Tiffany Wilson

I had a gastric bypass back in 1978 and I lost 138 lbs. and kept it off until 6 yrs ago and I started gradually gaining my weight back. This passed year I really packed on the pounds. I had Humana HMO but Doctor Bolar wouldn't take Humana so I had to wait until I could change my insurance. Finding a doctor that will do revisions of someone else's mistake is very hard to do. Well I changed insurance and got Bluegrass Family Health Ins. and guess what? Dr. Bolar decided to stop doing revisions for a while. So I was back looking for a doctor. I went to Dr. Geller but I never felt good about him he like Dr. Steiner are just out for the money. I finally found a Dr. Liu in Corbin, KY to do my surgery and Bluegrass denied me July 29, 2003. I have a surgery date of August 29, 2003 and my pre-op appointment was to be August 4, 2003. Dr. Liu sent a letter of appeal and we are waiting for an answer. They said that I didn't have 6 mos diet and also from the info they received that my weight gain was not due to my pouch mechanical failure. Dr. Liu put me thru the wringer and wanted to make sure that he could help me and not just be doing the surgery because of losing weight. I really like him as a doctor and I think his whole staff are great. I may have to wait until after the new year and change insurance again and this time I will go with CHA. Dr. Liu is one of their providers and my daughter had CHA and all she needed was a surgeon to say it was medically necessary. Hopefully, Dr. Liu will still do my surgery after the first of the year. If he won't then I finally heard from Dr. Argotti in Mayfield, KY. He said after 3 mos. and reading my old surgery notes that he would also do my revision. So I now have two surgeons that my insurance covers but have been denied once but I am hoping that they will approve my appeal.