I'm sooo depressed...

Well I found out today that my employer does not have a self funded insurance plan. We are fully insured, therefore, BCBS calls the shots and they say, NO SURGERY ALLOWED. Who made them GOD? Therefore, there is no way around the exemption (or so they make me believe). I am so depressed now. I have been crying, eating, sleeping, fighting with my husband (because I am irritable and upset) and then crying, eating and sleeping some more ever since I got the news. What a viscious cycle. This is just so unfair. I feel like I am trapped and will continue to be trapped inside this body forever. I am sorry to sound so negative but I just needed to vent and figured y'all would understand. My husband (God Bless him, just doesn't seem to understand what I am feeling and although he trys to help, the things he says just upsets me more-like dieting and exercising because we all know that losing 200 lbs is sooo easy right? ) says I should keep fighting and that somehow we will figure out a way for me to have this surgery. If only it were that simple... Well, I'm gonna go for now or else I will just keep rambling on and on. Thanks for listening and God Bless.

Tammy, was your information formally submitted to BCBS and a denial sent in writing? If so, even though it is denied as an exclusion, you can still appeal. There are varying levels of appeals and if you keep at it, eventually you get to an "third party review", this means someone not employed by BCBS that just might actually have some common sense. Another option, is to contact Walter Lindstrom's office (obesity law and advocacy center). He is able to assist people even outside of the state he practices in (CA). Their website can give you more info. If you do not have an actual denial in writing from BCBS and they just told the Doctor's office that it's excluded, not to bother; that is unacceptable. It still needs to be formally submitted so you can receive the denial in writing and pursue the appeals process. Hope this helps. Pam

Dear Pam, Thanks for responding to my post. I am sorry I have not responded back to you sooner than this but I have been very busy. To answer your question though, I have not yet formally submitted to BCBS for WLS. I was only told over the phone by a BCBS rep that it was excluded in my plan. I do not plan to give up and recently found out that beginning 1/1/06, all ins co's in TN will HAVE to cover WLS if the person meets the NIH guidelines! (see my most recent post for details) So, my faith has been restored and I am feeling sooo HAPPY right now. But thank you so much for your words of encouragement when I was feeling down, they meant so much to me. Everyone on this board is so great! Thanks again, Tammy

TAMMY, HAVE YOU CALLED BCBS YOUR SELF. I HAD A TEST SCHUDULED AND MY PCP CALLED TO TELL ME THAT THE CENTER I WAS TO GO TO CALLED TO TELL THEM THAT MY INSURANCE WOULD NOT PAY FOR THE TEST IF IT WAS FOR WLS. WELLLLLL I CALLED BCBS MY SELF AND SPOKE WITH A VERY HELPFUL FELLOW. IF IT IS MEDICALLY NECESSARY AND YOU MEET THE REQUIREMENTS FROM BCBS, ALSO WHEN YOU CALL ABOUT THE WSL ASK FOR A COPY OF THESE REQUIREMENTS, THEY WILL COVER. IT REALLY DEPENDS ON WHAT NETWORK YOU ARE IN WITH BCBS. GIVEM A CALL... KIP

Dear Kip Kat, I am so sorry it has taken me so long to respond to your post. I truly appreciate everyone on this board and all of the great advice and words of encouragement! I have called BCBS myself and they told me WLS is EXCLUDED on my plan. However, I believe that TN has passed a new law which mandates all ins co's to cover WLS if medically necessary (according to the NIH guidelines), beginning 1/1/06. Needless to say I am VERY HAPPY!!! Now we all have something to look forward to!!!!! Take Care, Tammy

I'm sorry you're depressed Tammy, Dont give up hope though! There's got to be a light at the end of the tunnel for you..Prayers seem to work for me so I'll add you to mine.. Take Care, Missy Lea

Dear Missy Lea, Thank you soooo much for your words of encouragement when I was feeling down. I really appreciated it. It feels so good to know that I have you all for support during this journey. I am truly grateful to each and everyone of you. Thanks for your prayers. Sincerely, Tammy

Tammy..does your insurance specifically say that WLS is excluded in your plan? If it does..then it will be hard for you to appeal..BUT PLEASE do so! I had been fighting for my approval through John Deere Select for over 5 months! I have spent countless hours, made MANY calls, wrote bundhes of letters, etc..I finally got an approval last week! I was told in the beginning I never would get the approval if I didn't follow through with 5 (FIVE) different appeals..There are several people on this website, that helped me...If I can do anything to help you..please send me an email and I will certainly tell you all I know, etc.. GOOD LUCK!

Dear Kathy, I am sorry I have not repsonded before now. I do appreciate everyone on this board for all of their advice, concern and words of encouragement. And btw, CONGRATS on your recent approval!!! To answer your question though, my ins policy does specifically exclude WLS. But, I do plan to fight, fight, fight them all the way and I hear that beginning 1/1/06, they won't have a choice but to approve me and everyone else that needs WLS!!! HOORAY for us! I would appreciate any info you could give me though on how you got approved. Please email me. Thanks again, Tammy

Hi Tammy, I am so sorry you are having to go thru this. I do understand your frustration, I haven't had to go thru the denials with the insurance, I have had to go thru 10 Dr.'s denials. So I understand about depression and anger. All I can say is hang in there, contact your insurance company yourself, get everything in writing. The more you fight and appeal, the better chances you will have in getting approved. I wish you the best in your journey. May God be with you and help you thru this time. Kathy