Been Turned Down!

I want to thank everyone on this board who has posted in support of me and my quest for WLS. I received a letter from Dr. Bolar's office today telling my that my insurance (BC/BS) has turned down my request for surgery. According to the letter, even if the diagnosis was morbid obesity, they would still not cover the surgery. So I guess I'm back to all the other diets to try again . I want to wish everyone good luck with their surgeries. May God be with you all. Rhonda

Rhonda, I am sorry to hear that! What you want to do is call the insurance company and find out what criteria exactly they are placing on you and why... Don't give up...appeal!!! I am hear to help! Rhoda

Hi Rhonda, I am so sorry to hear that. I too had BC/BS and they told me that they wouldn't cover the wls after 1/1/04. I had my surgery on 12/1/03. I wasn't sure though if it was all of BC/BS or just where I work. Anyway, I would look more into it. There might be a loop hole that you are not aware of. If you can not have surgery maybe you could try the Atkins diet. There are so many people at my work who are having success with it. May God bless you in your journey. Jill

Rhonda, My insurance also changed the first of the year, however since I had been in the process of gaining approval and had documentation since 7-03 I was "grandfathered" in and allowed to have the surgery. You might try appealing the denial. Good luck. Sandy RNY 1-26-04

Hi Rhonda ~ I too have been turned down because my insurance has a written exclusion for any treatment of obesity. I am trying to find a different job so I can get coverage that works for me. While you are in the mood you can: Sign petition & make Ins. Co. pay for WLS a law! Your help is needed! Click on the link below to help make this happen! And don't forget to write to your congress members. http://www.PetitionOnline.com/07221976/

Sorry to hear that you have been turned down. But listen to me..o.k. I work in the appeals department of an insurance company, here is what you need to do, FIRST, you must find out why the denied the surgery, if it is a true contract exclusion, then it will not be covered regardless of meidcal necessity, BUT......if the contract says under exclusions and limitation, Obesity surgery is excluded UNLESS medical necessary, then if you are 100 pounds overweight and a BMI of 40, you will be covered as long as your can prove serveral things to your insurance carrier. SO check on this first, and if your contract says covered if medically necessary, THEN appeal ASAP, and make sure you know the reasons why the denied you, you should receive a letter that explains exactly why this was not covered, if not call and tell them you want a copy of your file, per ERISA they must give you that information..GOOD LUCK, if you have questions please feel free to contact me...Patti in KY

Patti, I have CHA "commonwealth administrators" and I've been denied twice, So they say I dont have any further options ?? Other than a civil suit, The reason for denial was the surgery isnt covered unless you have a life threatening conditions. And I had no documentation if I had life threatening Conditions. SO I started what I call my "documentation project" I obtained a pcp and I'm starting to see him for everything that hurts me... LOL... I never realized that an ins company would punish you because you didnt run to the doctor every time the wind blew. So I've already had X rays on both knee's, Lumbar and thoracic X rays on the back. I had labs, and a PFT, I have an appt with an endocronoligst, and a GYN appt, I'm scheduled for a sleep study on 1-21-04. I was advised to get 6 months documentation of medical treatment and then re-submit my claim. Do you have any advice that would help me ?