Arbitration???? HELP!

Hi, My name is Nicky and I have been going through this for a couple of years now. I have BC/BS of TN. In my policy they have a written exclusion for weight loss surgery of any kind. I still tried to get it done though. I was denied and wrote a lengthy appeal letter with pictures and letters of support from my doctors. I was denied and filed a 2nd appeal. This time I went to Chattanooga in person and pled my case. I was denied again because of the written exclusion. I now have the choice of arbitration. My question is, has anyone here been through arbitration? or for that matter had a written exclusion and gotten it overturned. I appreciate any help you can offer, Thanks. Nicky

Hi Nicky, The only time I have ever heard of anyone who had surgery while there was an exclusion in the insurance policy, was when they went to their human resources manager at work and requested that they okay this as a one time procedure. They were able to persuade the HR supervisor to call the insurance and okay the procedure. Other than that if the insurance has an exclusion I have always been told you can do nothing because you can't force them to pay for something that they never covered in the first place. Maybe you could try this, hope it helps. Greg

Thanks Greg, My husband's company doesn't really have an HR dept. It is a smaller family owned company. I will ask the secretary though, she usually handles these things. Thanks again and have a great day! Nicky

Doesn't sound good Nicky, not to be a bummer or anything, but usually when there is a written exclusion there is nothing you can do about it. Arbitration is basically just pleading your case in front of a non-biased party & they will hear both sides of the argument & then decide, but this decision will be final. This is a legal & final decision so if you get denied there the buck stops there. So be sure to keep us posted & I'll send up a prayer for you right now. Candi

Thanks Candi. I know. I am hoping that with the Medicare changes that other insurance companies follow suit. Maybe by the time our policy renews in April there might be some changes. Congratulations on your surgery date! That is wonderful. I have researched the lap band too. I found a great doctor that will do it in Georgia for around $13,000,(which is 1/2 of what it is here) I am on Weigh****chers right now and have lost 25.6 pounds since April 12th. According to their goal for me I shoud be between 116-146lbs. With that being the case I still have at least 100 more to go. I started at 263.6 and now I am at 238. Sorry for getting off the subject. Best wishes for your upcoming surgery. I'll keep ya posted. Nicky