BC/BS Issues!!!!!!! :(

Hi Everyone, Well after waiting 5 weeks my Dr.'s office called and the girl that handles the insurance was very ticked off! Carrie called me to let me know that the insurance Co. finally sent something back to them. BUT, they were requesting paperwork for ONE piece of criteria they said was missed. Carrie told me she had written AND highlighted on the TOP of the FIRST page that I lacked the 12 month supervised diet the insurance Co. requests. She asked that they look through all my documentation regarding my medical issues and weight gain over the past 4 years. Well they IGNORED her highlighted note and simply wrote back for her to resend all documented info. This certainly was a downer for me, not to mention it upset Carrie. She told me she ws going to write to the head of the pre approval office and complain that they were requesting info she so OBVIOUSLY told them we were missing. She told me I should have an answer within the next 2 weeks. Has anyone experienced this. Some have told me its the insurance company's way of post poning having to pay for the surgery. I am totally depressed now. Any advice is much appreciated! Thank you in advance, Marlo

Hi Marlo, Is this something BCBS requires or part of the health plan your employer writes? I ask because BCBS is KNOWN for being very easy to deal with when it comes to the surgery. My surgeons office, when they called BCBS for the requirements, was told I needed 3 months diet history, a physicians summary letter, and have a BMI of over 40. That's it......................until we submitted everything last April. I was immediately denied because my employer wrote a clause in the policy that stated in addition to the above your BMI had to be over 40 for 5 years OR over 35 with a major comorbidity. None of that applied to me and we were very upset that we didn't know that from the start. BCBS said I fit all THEIR criteria but basically their hands were tied because my employer wrote a clause in the policy. As you can imagine I was devistated and let it go until August, when I decided to appeal. At that time I was told that "Due to a policy change with my employer as of June 1st, I am automatically approved" Don't get me wrong, I'm just thankful to have an approval, but it would have been nice to know about the policy change back in June. I could be 3 months post-op right now!! But hey, my surgery is scheduled for less than 2 weeks away so I'm not complaining. (Sept 12) Good luck with everything and let me know when you get approved!! Part of my diet history was a letter from Weigh****chers stating I have been going for a year but no longer had my weigh in booklet. If you want me to fax you that letter I will. Rachel

Oh, man. It's going to be a LONG weekend of worry. I'll be on the phone first thing Tuesday morning! I've got BCBS PPO. I've got my date - October 24. I've met the requirements that BCBS told me a year ago I had to meet. I had a bone density scan recently, just got my explanation of benefits back from BC. It's not covered because they don't cover them if it's for ... they had three things, the last one being obesity related. WLS was covered when I called a year ago. This will be terrible if my employer added a restriction since then, but imagine how bad it would be if it had changed, I didn't know it, and had the surgery! Hurley and BC both told me they don't do preapprovals. Marie

So you've been approved and have a date but now they're trying not to cover it? Man....that's got to be so nerve wracking!! Best of luck to you. Rachel

Well, I've never heard of the employer putting in a clause excluding something before, but when I got that explanation of benefits back with not paying because "obesity related," that raised a red flag. They don't do preapprovals and put anything in writing. Hopefully that related to just that one test. Marie

if you read my profile. The letter from my PCP to the insruance is there. I hope it helps. It got me approved with-in sec. K~