SCREWED BY BCBS of TN AGAIN...

Hello fellow Tennesseans, I already posted this on the Insurance Help board but wanted to post it here as well. Okay, I am really upset (seems like dealing w/BCBS of TN has that effect on me lately). Anyways, I know I have an exclusion on my policy for WLS. However, now they are refusing to pay for my regular medical care because my primary diagnosis is morbid obesity! I went to the doctors last month for swollen glands and chest congestion. During that visit, I ended up discussing my weight concerns with my doctor. He referred me for a sleep study because I had the symptoms of sleep apnea. He also did blood work (for the swollen glands). Well, BCBS of TN sent me an explanation of benefits where they are saying it is a denied service on my policy because I have an exclusion to any services relating to obesity or morbid obesity!!! I called my doctors office and they told me that anytime you discuss weight concerns in a visit, they can refuse to pay because of the exclusion! Yet to build a case for WLS down the road, I have prove morbid obesity and comorbid conditions as well as a medically supervised weight loss plan! So, what am I supposed to do now? How do I get around this or am I going to have to pay out of pocket everytime I go to the doctor now? Frustrated in TN Tammy

Keep appealing, Tammy. That's all you can do or change policies. You just keep fighting them, and call them, send letters, pictures whatever it takes to get their attention. But don't you give up. Inform them by having the surgery, how much they will save in medical costs down the road. With obesity, comes a lot more medical, more medications, more specialists, more tests, more etc. But you do what ever it takes to get their attention. Hound them daily, write down names, dates, times, keep a log. If necessary, get an attorney, one lady sued her insurance, and won. Best of luck to you. Kathy

Thanks for the info and the support Kathy! It means a lot to me. My husband is trying to get a hold of Gary Viscio at Obesitylawyers.com to get some legal advice on fighting the exclusion on my insurance policy. I am also going to apply for a state job because their insurance (even though it is still BCBS of TN) does cover the surgery w/a 6 month medically supervised diet. I kinda hate to switch jobs but I don't know what else to do at this point. I may try to talk to our benefits coordinator in HR again but I don't know if there is anything she can do, besides, she is the owners wife and I don't want to cause waves and possibly jeapordize my job. Oh well, I'll figure something out. Thanks again for your support. Tammy

KEEP APPEALING TO THEM. I HAD A FRIEND WITH YOUR INSURANCE AND HE DID HAVE TO PAY SOME OUT OF POCKET BUT NOT SURE HOW MUCH. I WOULD NOT GIVE UP. THATS PROBABLY WHAT THEY WANT YOU TO DO.

Kip Kat, Thanks for responding to my post and for your advice. I really appreciate it. My doctor's office is going to resubmit the claim using a different diagnostic code and hopefully that will work. My husband spoke to Gary Viscio this afternoon and he said that BCBS does not have the right to refuse to pay for my medical care just because it relates to my morbid obesity. He said with the exclusion they can refuse to pay for WLS but that they're being discriminatory by refusing to pay for the other medical costs that just happen to be related to my obesity. So, I am going to call him back tomorrow and discuss my legal options on how to fight this. Thanks again for your support. Tammy

TAMMY, FIGHT, FIGHT, FIGHT, UNTIL YOU **** THEM OFF ENOUGH TO PAY FOR IT ALL. I HAVE SEEN EXCLUSIONS WIN...BUT YOU CAN NOT GIVE UP FIGHTING....WRITE LETTER AFTER LETTER COMPLAINING HOW YOU FEEL EVEN IF YOUR "POOT" STINKS BECAUSE THEY WILL SEE THE LIGHT EVENTUALLY....GET OTHERS TO WRITE....GET DR TO WRITE....PREACHER EVEN BECAUSE THEY WON'T APPROVE SURGERY YOUR SERVICE AT CHURCH IS AFFECTED...APPEAL THIS LATEST ONE BECAUSE YOU WERE SICK NOT JUST WEIGHT ISSUE...THAT JUST CAME UP....DON'T GIVE UP....HANG IN THERE....WHEN YOU WIN WE WILL HAVE A JANELLA

Hey Janella!!! Thanks for your advice and support. It really means a lot to me. As you can see from my responses to Kip Kat and Kathy, that I am going to fight this. My doctor's office is going to resubmit my claim using a different diagnostic code and see if that works. Plus, my husband spoke to Gary Viscio about my legal rights and he says we can fight this! So, I am going to call Gary tomorrow to discuss my legal options. But Gary told my husband that they are being discriminatory by refusing to pay for my medical bills. So, we shall see... keep your fingers crossed for me. I am going to fight this! By the way, how are you feeling? Thanks again, Tammy

Hi Tammy, girlfriend , I have Bc_stinkin_BS of S.C and we also have a lovely little written exclusion And I just found that out this week, I am just beginning. SOOOOOOOO looks like I will keep being overweight and unhealthy, cause hubby scoffs and thinks I just need to get off my butt and excercise Is he overweight ? HUH, barely.......... anywho, U are not alone!!!Soooo I am frustrated in TN with ya girl!!!

Hi Deana! My husband was the same way until he did some research on WLS and went to a seminar with me. Now he seems to understand more, especially because my health keeps deteriorating. But, he still, on occassion (knowing that I have the exclusion and may not be able to get the surgery) will go on the "you just need to diet and exercise" tangit! I know he just means well and I am sure he gets frustrated hearing me whine about it all the time. Hopefully, TN will pass that WLS law next session and all of us Tennesseans will be able to have WLS. Would love to be a fly on the wall when BCBS hears the news that they will HAVE to cover WLS! Keep your fingers crossed and hang in there! Tammy

Girls, Guys, Just a little note, I know how you feel about not being able to have surgery. I have bcbs of tennessee also, and what was once thought of as a wonderful blessing it has turned into a curse. I just don't want you all to fall so low that you don't think you can get better... I have been there.. and you have to pick yourself back up and keep trying... We may not be able to get it yet... but the longer we try and do as much for ourselves as we can in the meantime the better off we will be for surgery day... Keeping you all in my thoughts and prayers, Tina