Help denied 2nd time Preferred Care

I need your help, if you have Preferred Care and have been approved for WLS I need to know. Please respond or send me an e-mail off line. I was denied again for the second time. I can no longer appeal, and the only thing that my attorney told me is I can sue them and they can not approve anyone that has not done a multidisciplinary program. Hence for me was their One to One Program. I had documentation of weight loss success and failures going back to late 1970's to current. I also had two letters of medical necessity and also have paid out of pocket over $2500.00 in medical bills to get surgical clearance. I called them back in March to get all the requirements and criteria that I needed, and since I did not need any referrals for any medical appointments I went a head and started my journey. Now 5 months later, denied twice and I can't appeal again. I have gotten lots of advice from all to never give up. The only thing I can do now is to pick an insurance provider for 2006 that covers and ensure I get all their requirements too. Please get back to me if you have PC and also if you have/had surgery. Thank you all in advance......last time I got denied I got shingles, I am not letting them get to me this time. Lucy C

Lucy I'm so sorry to hear of your delimea.....I do understand what you are going throu.....Why can you not appeal again....I was denied 3 times til I got approved....I sure hope you don't give up cause then you are doing just what they want you to do.....I don't know who your attonery is but does he specialize in WLS issues....if not you might want to look into the one they have here at OH....he specialize in fighting the insurance for WLS..... I will keep you in my thoughts and prayers and hope you never give up....I'm so glad I didn't give up even thou I wanted to....I was told from many people here on the board who supported me through the ordeal....not to give up....so they were behind me and I never gave up and now I am on the losing side.....and I believe you will be on the losing side with me..... Christine 346/231/?

Thank you both for responding to me. I have no recourse with PC, the only option left is to get an attorney. I did phone one yesterday using the add on OH...here in NY. Because of the policy I have, my only option is to sue them. I don't have any more $$ to give. My intention is to change back to Blue Choice for 2006, and start from there. I did have a surgery date of 10/24, but now it won't be till next year. That's ok, I will wait, everything happens for a reason. My surgeon can't help me, for PC won't even take his calls. I did however write a letter to the CEO and Director of Operations and told them what I thought. I know it won't change anything but at least I said what had to be said. It doesn't matter to them that two doctors had letters of medical necessity. My last line on my letter was..."But let us not forget it all comes down to the Corporate bottom line, and not really to get people healthy." I guess I will update my profile and put it on there. I will never give up for journey for WLS. Thank you every one and I will go back to being a lurker. Lucy

Lucy I am veryyy sorry about this. Please dont give up, this is where you step over that bump in the road of your journey and work hard to get to the palce your longing to be. I have Preferred Care, I did not however have it when I had my WLS, I will tell you, I HATE it ! As I am moving into my plastics at this point, I am moving forward with little no NO hope PC will cover ANYTHING. I doo have a great human resource director at work who is working on bringing back BCBS as a 2ndary insurance.. Mainly for me, and in hopes this insurance provider will be more helpful and useful to me.I could not ask for a more supportive group of people to work with. I dooo encourage you to find another insurance provider if its possiable for you to do so. Good Luck Lucy and PLEASEEEE do NOT give up.

Lucy - In reading the responses I got an idea - who says you have to stop. Ok so they won't take any additional requests... says who? there is no one saying that you can't continute to send in letters of request, make phone calls and talk to a person every time, continue to write/ call the CEO. If nothing else you know that you would be bugging them and that migh bring some personal satisfaction. "They" say that you hve no recourse and maybe by there rules you don't but they can't stop you from contacting them and making them uncomfortable. It will likely make no difference and changing your insurance is likely the only true path to take but you only loose the price of stamps for the letters and some time for the calls. I don't know it was just a thought. Ann