my Denial

I got my letter from BCBS today ! Wow seems my efforts to diet have hurt me . It's said I was not morbidly obese 4 of the 5 past years . But they are wrong because I would starve before I knew I was going to see the Doctor . I did not want Him to know I had regained again. My weight has went up and down about 30 pounds over the last 6 yrs. I have had 30 plus years of diets trying to stay under 260 . I have been well over 300 lbs many times in my life . What do I do? I'm sick of being fat  Lynn

What is your insurance company? Are you currently not meeting criteria, or was that in spell(s) of the past 5 years? Is this their first response or have you appealed? They told me at my docs office that for folks who get initial denial from ins. companies, of those that take the time and go thru the appeal process, 99% of those get approved.  If you haven't already done so, chat with the person at doc's office who works with the insurance companies for approval.  He/She can be a wealth of information for you in how to "play the game" to get approved.  They've "been there done that" and typically know the secrets of getting around denials.  They want you as a patient (and that $$) and are usually very willing to let you in on those secrets on how the game is played. Good luck... don't give up YET.  You just have to have tenacity to WIN. 

I can tell you for sure I'm not going to give up . I want this surgery I need it to help better my life. I have the nc statehealth plan of BCBS  I have 31 yrs of obesity..I hate that word .

My office also told me that BCBS is one of the best "payers" and approve more WLS than any others, so things still look good for you. Just keep that determination and play the game.

Lynn -

I have heard similar comments to what Lynn said. Call the office and ask them to work with you. Also you may want to call BCBS to get some clarification as you arm yourself to move on to the next step. If you haven't done so already, see about posting your experience on the main, rny and insurance boards to see if others have had the same and/or similar issues and how they resolved them.

((((Hugs)))),

Barb

P.S. I'm also warring re: insurance for my husband's rny ... I know it can be really stressful, but you can do this!

Dr.K just called me. His gave me some good info that might help . workie workie

Lynn
I hope everything works out for you. If not you can always borrow my Tricare card... they never turn anyone down and pay 100% Best of luck to you!!!


Darcie

Hey Lynn,      I know how much that sucks because UHC denied me...and my appeal...last year. I heard about Vocational Rehab and gave them a shot, never expecting approval, but got it in December.       Something to think about if BCBS doesn't approve you, although I'm quite sure they will. Keep The Faith!! xoxo Mare

Lynn, I was denied twice by bcbs mostly for evaluations that needed updating. I fought 3 years to get my surgery and I am so happy I stayed the course. I also wrote an appeal letter which I hand delivered to bcbs and was approved two weeks later. Wendy is so right that the doctors want the $$$$ and they do know all the tricks of the trade with the insurance companies. Did you know that the doctors may say the surgery is say 30 thousand but once you are approved the insurance makes a deal with the doctor for about half of the said amount. I got this info from my accountant.                                                     Annie

Lynn: I have BCBS PPO state plan and I did not have 5 consecutive years. They used years for when my BMI went over 40 and I even used my Weigh****chers sheet for one of them. I went back years to get them and one I was just barely there. Go back and have them file additional years that show you have had the high BMI. Hopefully you have the documentation. Appeal. Lisa