2nd Level Appeal Denied BCBSIL. Please Help!!!!

My first level appeal was denied because they said I did not meet the criteria for the documented failure of 12 months medically supervised weight loss. My second level appeal was denied but they said it appears to be documented failure of the medically supervised weight loss, Yet they don't see any extenuating cir****tances that would make the procedure medically necessary. I have exhaust my appeals with my insurance provided through my job . Does anyone know what I can do next ? No one ever said that you had to be on your death bed with the co-morbities to be approved. I have high blood pressure, and Sleep apnea. I am unable to sleep with my CPAP mask and I take meds every morning for EDS (excessive daytime sleepiness) my BP is currently doing ok but I do suffer with swelling of the ankles and hands and migraines. I have been trying to get approved since my consult back in Jan 05. At the end of the denial letter they said something about I have the right to bring a civil action in federal court in accordance with ERISA Section 502(a). I don't have a clue where this is leading me. Please someone give me guidance...

I am so sorry about the appeal. The Erisa Section 502(a) involves getting an attorney and filing a law suit against your insurance company. I really don't know a lot more than that, what I know is that OBESITY IS A DISEASE JUST LIKE DIABETES AND CANCER and basically insurance companies are picking and choosing which disease they will cover. I am really sorry about your situation. Let me know how you do. God Bless.

Thanks for the information. I filed a complaint with the state department of Insurance this morning I don't know if they will be able to hel*****t. I guess I will be finding out shortly. Hopefully this will lead down a positive road.

Contact Gary Viscio, he is a obesity lawyer. He is also a member of OH. Go to Find Peers, he lives in NY and u can find him by clicking on his state, NY, then the first letter of his last name. He is there. I am sorry I don't have his email but u can email him from his profile. I know he can help u. I almost used him myself but was approved before I could hire him. Good luck and Gary Rocks! Contact him asap! Angela

Hi, I am in the same boat. BCBS. I had a VBG failed. Now my insurance says it does not cover it anymore. Even with the problems with the first surgery. My doctor Rodriques has written letter. it has been 5 months. I just went straight to the lawyer. I hire Obesity .com Kelly Lingstrom They are on the trail. I hope this works. 800 is better that 23000. dollars to self pay. Patty

Patty, Please let me know how it works out for you. BCBS doesn't want to pay for it period. They want us to jump through these hoops and then still turn around and say NO. Don't give up girl because I sure am not going to. I would pay 800 for a lawyer to. If It would make them pay for the procedure. I wish you luck. Please keep me posted. Thanks