Grievance Appeal Letter 06/12/05

Greetings to All... It is Sunday evening and I have all my paperwork, Medical Records, Appeal Letter, Photos and among other things ready to send off in the morning to BCBST. For those of you who have been turned down by your Insurance, you know how I must feel. This is the second time that I was turned down by the insurance company. The second time I was turned down, I figured it was time to fight back for what is mine. I need all your prayers that the Appeal will be in my favor. I will wait for an answer and kept you informed. Thanks to All in advance. Rhonda

I also have BCBS and so far they have covered all my test. Haven't applied to them yet for surgery. I hope they approve me but if not there going to know me really well Good Luck...

Rhonda, I have BC/BS of IL as my secondary insurance and I could never get the rascals to approve my WLS. I was lucky my primary insurance (CIGNA) approved me and as I'd almost met my yearly limit, they paid it all but $37.50. Good luck and I'll keep you in my prayers. Kelly Open RNY 10/19/04 -135lbs and still losing

Hi Rhonda This is my very first time on this website, and my very first time to do anything to try and get this surgery for myself. I also have BCBST, and I specifically have a clause denying bariatric surgery. I am severely obese, with high blood pressure, sleep apnea, diabetes, arthritis, and a former knee injury, so I really can't do a whole lot to get rid of this weight. My mother successfully had this surgery several years ago, so I am sure this is the right thing for me. Can you please offer some advice as to what I should do first? I know I have to go to the seminar. But what next? I am a little scared of getting myself psyched up and then being turned down. Thanks for any advice.

Right off the bat the insurance denied me. After I was denied. I started digging for all my medical records. Records from my PCP and a letter that stated I was Medical Necessity. My sleep study test I had them fax me my records. My arthritis doctor had them to do the same. Everything I could find that would benefit me I sent. My mother passed away this past November, on her death certificate it stated the cause of death.. Morbid Obesity, and Diabetes. I sent that in. Diabetes is passed down for generation to generation. So my advice to you is to start getting all your medical records of any kind. Hope this helps. Rhonda

I have BCBS of Alabama but live in Tennessee. I was denied the first time I went for approval due to not having the paperwork of 6 months Dr. supervised diets. In the middle of approval they changed the requirements so I had to fight it because when I turned in my packet for approval that wasn't one of their guidelines. I fought through my company to have it approved, sent a picture and a letter and the second time it was approved. Moral of the story... you know it is right for you and you are the best advocate for your health... fight, fight , fight!!!! And Good Luck..