Insurance coverage...Help!!

Hi-
I'm fairly new to this site but am hoping someone might be able to offer some direction or experience in this matter.  I just met with my wonderful surgeon for the first time in Pittsburgh and am soooo excited about all of this.  However, was just thrown a wrench: Blue Cross of PA will not cover this surgery.  I'm going to file an appeal but my heart sank to the floor when I got this news.  I have fibro myalgia and have alrady had numerous ruptured discs surgeries.  The surgeon confirmed my hunch: that not only would taking off the weight improve my health but my fibro-m and disc ruptures would lessen greatly.  Why wouldn't BC of PA want to help me...but they'll pay for a dozen back surgeries? Thanks for any thoughts you can provide!!! -Leslie

Have every Dr you have write a letter documenting why this surgery will help you - family Dr, chiropractor, back surgeon/physical therapist/orthopedic, who ever you see for your fibro., OB/GYN - whoever you see. This will help your cause with the appeal.

Best of luck!

Liz

PS - I had my surgery with independence blue cross/blue shield so maybe they'll cover a different surgery/surgeon? RNY vs another surgery or a different hospital Best thing is to call your rep. since each policy is very different.

 Hi Liz-
Thanks for your thoughtful reply.  I will put this in motion and make sure I get those letters.  I'm so nervous as I work very hard but don't have $20K+ to pay out-of-pocket for surgery.  Argh!  Many thanks!!! -Leslie

I have had a lot of experience in getting denied. It actually took me almost 6 years. First, find out WHY they denied it. If it's an exclusion in your contract, nothing you do will help. Trust me, I even tried suing.  My second insurance claimed to cover it, but was never satisfied with my choice of surgeons. Had a surgery date, but my surgeon got so disgusted with their nonsense, he cancelled my surgery. So I switched to one they said they worked with SIX hours away from me and That did not help. They made me jump through so many hoops for three years. I even had a surgery date then they told me they wanted me to do another 6 month, physician assisted weight loss program and I finally gave up after 3 years of jumping through their hoops.

However, when I finally switched to BC/BS PPO they agreed after my first letter but the site I went to was one of their preferred sites, so that helped. So find out WHY. It may just be that they want you to work with one of their preferred surgeons. But if it's an exclusion in your contract, I'm afraid there's not much you can do. I'll keep my fingers crossed for you

Good morning-
Thanks for your reply and it's inspiring.  I'm a wreck over this and cannot imagine what you must have gone through.  I truly admire your strength and commitment.  My health, chock full of co-morbidities, is at great risk and I'm still quite young.  I know this new fight is just beginning but am weighing the options of fighting insurance or just putting myself in deep debt by paying out-of-pocket.  Now I need anxiety medicine! 

First find out why they denied, then go from their. I am STILL dealing with anger issues because in the 6 years I was trying to get help, I developed Diabetes along with High Blood pressure, depression and high cholesterol.  I am deeply angry. The six years of Drs., meds, classes must have been double the cost of WLS. But I would find out exactly why because BS/BS usually pays. It may be an exclusion in your particular group or it could be a simple as going to another surgeon. GOod luck.