Insurance problems

I posted a few weeks ago assuming all was going well with getting everything in order to resubmitt to bcbs. Friday I got another denial letter. I am having a very hard time trying to decide why they are turning me down again plus they are saying the only way for another review is to send in an appeal. I had two friends look at this last letter. One works at the hospital the other works at bcbs. Both have said something is very wrong. The gastric bypass nurse returns tomorrow and I am hoping she can explain what is going on and what needs to be done. I am so confused and just do not understand all this trouble. I have even requested a amount from the hospital for the surgery in case I just throw my hands up and say SCREW YOU INSURANCE I will pay for it . My DH told me the other night he loves me no matter what. Sorry I wont accept this when I know I dont have to be morbidly obese the rest of my life. I really want to just stuff my face but with the byetta I am taking I know I cant do it. So any advice would be great. I have even thought of going in person to the insurance company and let them know how life is for an obese person.                                                             Annie

Hey Annie, Boy, do I understand how you feel. It was a year of fighting the insurance company for me and it was one of the most emotionally draining times in my life. Give yourself a couple of days to calm down then start doing your research. There is an insurance forum on here that may give you some good ideas on how to start the appeal process. It is run by my former, horrible lawyer. However, despite his complete incompetance in my case, he does know his stuff and gives free advice on the message board. Just DON'T HIRE HIM!! Kix can back me up on this one. Keep fighting them - they basically want you to just give up, it's one of their little tricks. good luck!!!!

Thanks for the advise as a matter of fact I was reading about bcbs in nc and the experincesmembers have had with them. If I ever get to surgery I will never figure out why this golden carrot dangles in front of us. Also why do you have to fight so hard for this when it is already a very big choice on our parts filled with fear ect...                                                        Annie

Yeah, what PJ said!  Her experiences with that particular attorney were worse than mine -- he did such a craptacular job with my appeal that I don't know how I won at external review.  I would not recommend him to anyone. What exactly did your letter say?  Maybe we can figure out what the heck their problem is? If you do have to appeal, don't just forge ahead without being extremely prepared.  You don't want to torpedo it by neglecting something necessary for winning your appeal. We're here to help as much as we can. Kix

Hi Kix, The first denial letter said my phych eval was older than 15 months go have another one. Ok did that within days of sending the updated eval to them. My mother has a good lawyer but to get him involved would mean more time more money ect..  I have been fighting to have this surgery for almost 3 years now. The first letter states the reason for denial was: The requesting surgeon has not recorded a physical examination other than the members vital signs. The psych eval provided is over 15 months old. This was sent March 27th. The letter I got on Friday says : reviewed info. Member has morbid obesity for 5 years but there (mispelled by bcbs) physical exam only has vital signs. So by looking at all this again it appears they want more of a examination but my goodness I have had a zillion test. Also looking at the criterior you have to meet I meet each and everyone so what gives. I hope to get more answers by tomorrow from the nurse. I am so glad people like you Kix, and PJ and all the others are here. If and when I go to surgery I think I am going to be so drained from all this I wont have it in me to be a scared $#%^&**( I will just want to get on with things.                                                Annie Any ideas on who can help me with a web site on here would be good too. I wrote OH for help but havent heard anything.

Thanks Julie for putting things in perspective. Im not going to stop fighting for this and yes the doctors have the magic pen. I am glad I can come here and talk about this. I just have a hard time seeing how hard it is to have this surgery. Ive been fighting to have this for 3 years now. Thanks again.                                             Annie

HI Annie.  I was very blessed to have folks in the cust service area at BCBS work with me.  I would suggest calling and asking for help (use a supplicant tone, not an aggressive one).  The first time I called (just after my initial submission) I got the name and extension of the gal I was talking to and asked if I could call her for updates.  She was glad to help.  I then called every two to three days.  I always asked for her, but if she wasn't available, I talked to someone else.  I made sure I knew the status up to that point, so when they said "I see that they sent a denial letter on March 27" I could tell them that the denial and the added info needed crossed in transmission, etc. etc. Each person was supportive and a couple of times, the person I talked to got pretty ticked off with their internal processes and said "Let me get this handled" and would personally take steps to get stuff where it had to be.  When I did get approved, my first rep was talking to someone else and so another rep got to tell me I was approved.  After I hung up, I actually got a call from my first rep telling me how happy she was for me and asking me to keep them updated.  Long story long . . . it pays to get someone (or someones) at the ins co cust service desk on your side to help you thru the red tape.  Get yourself a champion there, and see if they can walk you thru what needs to happen next.  Good luck!

Hi Robin, Great advice and thank you so much. Fortunatly my nieghbor works at bcbs and I just heard back from him through email. He also has a copy of the last letter. My mom thinks I need to go there in person but if I do dont worry I will be all goodness and light. It is the southern way you know LOL. I really am not a mean or hurtful person I am just at my wits end here. Once again the people on this board are the real hero's. Also Robin keep up the good work I noticed  your weight ticker you are doing great.                                                                       Annie