INSURANCE NIGHTMARES

THIS IS IN ADDITION TO MONIQUE'S REPORT ABOUT BLUE CROSS BLUE SHIELD OF ALABAMA AND THE CHANGE TO THEIR GUIDELINES. IT'S NOT JUST THE BC/BS OF ALABAMA, BUT I THINK MOST ALL OF THEM ARE CHANGING THEIR GUIDELINES. MY BEST FRIEND WHO WAS 2 WEEKS BEHIND ME ON EVERYTHING-1ST MEETING WITH DR RODRIGUEZ..GETTING ALL TESTS AND REPORTS DONE AND FILING THE INSURANCE...WE DID LOSE A COUPLE OF WEEKS ON THAT DUE TO THE STRESS TEST. WE BOTH WORK AT THE SAME LOCATION AND HAVE THE SAME INSURANCE..YET SHE HAS BEEN TOLD 3 DIFFERENT TIMES THAT SHE DOES NOT QUALIFY PER THEIR NEW GUIDELINES..WHICH DON'T EVEN TAKE EFFECT TIL 11/29. HER LAST PAPERS WERE FILED AUG 6TH WITH 6 YEARS OF DOCTOR HISTORY AND 6 MONTHS OF WEIGHT LOSS. THEY WILL TRY AND PUT YOU OFF...LIE TO YOU...AND CONFUSE THE ISSUE AS LONG AS THEY POSSIBLY CAN. PLEASE BELIEVE THIS. I WOULD NEVER HAVE BELIEVED IT HAD I NOT SEEN IT 1ST HAND. PLUS-HAVING OBTAINED THE PRE-DETERMINATION APPROVAL FOR MY SURGERY..EVERY STATEMENT I HAVE GOTTEN FROM BC/BS HAS BEEN REJECTED AND HAD TO BE RESENT WITH THE PRE-DETERMINATION LETTER ENCLOSED. THIS IS LIKE THE RIGHT HAND NOT KNOWING WHAT THE LEFT IS DOING. YOU NEED TO KEEP GOOD RECORDS ALWAYS..KEEP COPIES OF EVERYTHING YOU RECEIVE FROM THE INSURANCE AND THE DOCTORS OFFICE--IT'S AMAZING WHAT THEY ARE TRYING TO GET OUT OF PAYING. EVEN MY HUSBAND WHO HAS A DIFFERENT BC/BS AND WHICH INFORMED ME THEY DON'T COVER ANY WEIGHT LOSS SURGERY OR SMOKING CESSTATION PROGRAMS, DID PAY THEIR PART OF THE LAB TESTS PRIOR TO THE SURGERY. HOPE THIS IS AN EYE-OPENER...IT HAS BEEN FOR ME. RENEE

Im not an expert on insurance approval , but im sure a lot of the approvals or denials are determined by the person whose desk the request for surgery lands on. When dealing with these people try to remain calm,and friendly. I know its not easy to do but remember, they can make or break the "deal" and its easier to get someone to do something for you if they are not mad at you. Ged mad after the approval.