BCBS TN help

I have BCBS TN Network P and my employer has asked that our policy be rewritten and have received a no-way answer. BCBS has however said that I should file my claim for surgery, they will deny the claim, and I will need to file grievance and continue to pester them. Is there anyone out there who has been down this road before and if so how many appeals have you gone through and when did you finally get approval? This whole process is so frustrating and irritating. Thanks! Laundrea

Laundrea -- I don't have BCBS, however my ins company was delaying letting me know something.. I finally had to get ahold of my company and have them to mail me the specific "plan" they purchased for us. after I got that, I noticed that in the EXCLUSION page was WLS..however, they had a claus in the fine print ( unless diagnosed with morbid obesety ).. after I saw that.. got my letter written by my family Dr stating that I was in that catagory.. things went much quicker then... good luck and keep us posted... remain calm -- this is for a new you...

Hey Laundrea, The company I work for just changed to BCBS of TN & I am on the P network also. We actually could choose Network S or P...S would not cover Jackson Clinic or Centennial that's why I went w/P. When I found out I was changing to BCBS, I called and was told they were not covering the wls but could possibly change later in the year of 2005. I work for a smalll company & in order for BCBS to cover the wls, the company would have to purchase a rider. I think Alabama changed in 2004...at first they weren't covering the surgery then it changed. I had Humana before and they had exclusions...as long as an insurance company as exclusions, I was told there's no reason to try to appeal because they won't ever approve you. Have you ever heard of this??

My employer asked about a rider. BCBS said no. Then we started asking about re-writing the policy so that WLS would be included. Yes, it was excluded from our policy. BCBS said they would not re-write out policy and never re-write policies and that the best bet for me would be to just file the claim and go through grievance. It's funny because BCBS just sent our their latest newsletter that said they would begin to cover some plastic surgeries like nose jobs, facelifts, liposuction. I got so mad because here I am struggling just to get some help with my health and they would rather pay for me to look 10 years younger!!! I'm not going to give up . . . if I have to self-pay then so be it. L

Hi Laundrea, Good luck with BCBS. Two years ago I filed with them for WLS. However, there was a WLS clause in the policy and even though I had letters from 4 different Dr.'s stating this was a medical neccesity I was denied. I filed 3 appeals and was turned down flat. I finally contacted an attorney and after he looked at my policy the lawyer told me I was fighting a no win situation with BCBS. My husband changed jobs last year and he now has Cigna. I was approved through them and my sugery is the 6th. Good luck with BCBS. I will pray for your success. Becky

Sorry to hear you are having such trouble. I have not been in your situation but I just wanted to say my heart goes out to you because this is such a frustrating time. I hope you find the answers you seek! Good Luck! Meryl

I had BCBS of TN and had no problems other than the main ones that most people have. read my profile for my story. good luck.

I have BCBS of TN and it took me about 3 appeals, I think. Just keep trying. Be very persistent. After you send in documentation, call to make sure it is received, get a date for a decision, call back on that date for an answer or to make sure they are working on it. Send documentation for eveything they ask for. Get a copy of your policy and read all the fine print. If they are telling you to file a greivance, there must be some hope. Also, get your doctors office (WLS doctor) to work with you. They can help as well. As a last resort, get a lawyer. Sometimes just a letter from a lawyer lets them know you are serious. Best of luck! Lisa HUffstetler Surgery: 8/11/04 -70 pounds so far!

Thanks everyone for your words of encouragement! Insurance is such a racket! I know they just want to see how high I will jump to get this paid for. Just wait they're going to think I'm Michael Jordan! Laundrea

Hi Laundrea, I have nothing but bad things to say about BCBS. I never got a chance to file with them, because when I got married, they kicked me off my mom's insurance (I was expecting that) and denied me COBRA conversion. COBRA is a federal law. My mom was a state employee and when she called them they blamed it on the state. She called the state and they blamed it on BCBS. Needless to say, we went round and round, and nobody will do anything. The final story was, BCBS forgot to tell the state that I was terminated from my mom's policy, so in turn the state forgot to tell me I was eligible for COBRA. Now, the state and BCBS tell me it is too late and I missed the deadline (of course, I never knew there was a deadline, because no one ever sent me a notification of eligibility). So here I sit, two years later, with no insurance at all. I hate BCBS. In my opinion, they are one of the worst insurance companies out there. I'm sorry I don't have something better to offer! I wish you good luck with them!