DEnied again

CAn I tell you how much I hate BC/BS?????? After sending what they asked for after the first denial I was denied again saying the same thing except this time they said they could not accept a letter from my doctor. They want medical records for 3 years and the 6 month proof has to be in my medical records which it was not. So, I am starting from scratch with the 6 month of going and checking in with my doctor. I really can't loose more than 20 pounds on any diet and if I do are they going to deny me for losing 20 pounds/? It will also change my BMI! They play such games but I am determined to win!! Anyone else do the 6 month diet and what did you do? Karen

Do you have any co morbidities? I am not trying to be nosey, but curious why my surgery was approved and yours not.......... of course, my insurance is from a self insured group, and this is just the first year with BCBS. The previous ins. approved WLS apparently without problem.... so maybe they were stuck with a year of the same kind of coverage and if my request was after May 1, 2005...... I might have been denied flat out! One thing they did tell me was that WLS did not require pre-approval if it was outpatient. I thought YIKES! I said, yeah, and what happens if you run into a problem in the hospital, he said the same thing that I have been told before by the hospital about outpatient surgery stuff.......... the hospital calls and gets approval for you to stay in the hospital longer. Mine is approved for one day......... and I was told the hospital will call them if I need to stay longer, and they will approve it.

Sorry you are going through this, but more and more insurance companies are making people do this. Just be happy they don't require 12 months like some of the BCBS companies do. What state is your policy out of? I know AL requires 6 months, but TX requires 12. Louisiana Blue Cross pretty much won't cover it no matter what. (The employer the policy is through has to purchase a rider to add Bariatric Surgery and it's apparently very expensive, I only know of 3 companies that have purchased it for their employees) Self insured policies are different, some will approve easily, some will not. All I can say is like Susan, JUST DON'T GIVE UP! Make certain your pcp makes plenty of chart notes about every detail, like what kind of exercise he prescribes, how many calories that kind of thing. They will need actual chart notes and not a summary letter. You can actually pull up the criteria on the companies website. If I were you, I would do that, print it out and take it to your doctor so he will see it for him/herself. Don't take chances. Hang in there! It can be done! I've seen it happen. You'll be surprised how quickly 6 months can pass.