Alabama Court Rules DS NOT Investigational!

I WON!  I WON!  I beat BC/BS of AL in my ERISA Federal Lawsuit!!! I began my quest for WLS around 3 years ago, and decided at that time that I didn't want an RNY but a Duodenal Switch (DS) that BC/BS of AL wouldn't cover because they claim it is "investigational." BULLFEATHERS! Anyway, very, VERY long story short....After appealing for two years with no change in their bogus policy, I found out my only recourse in the state of Alabama is to file an ERISA lawsuit in Federal Court. (MOST other states have review laws where a State Insurance Commission will review all health insurance claim denials). I filed the lawsuit in October of LAST YEAR, and then went out of country to Mexico and self paid for my DS with Dr. Ungson. Just found out today  that the court ruled in my favor! The judge gave BC/BS AL's medical director a sound spanking in it's decision that the denial was arbitrary and capricious! What does this mean to YOU? It means that if you have been denied the the DS as "investigational"  there is a now a court ruling that it is NOT an investigational procedure and they cannot REASONABLY deny coverage! Insurance companies will be hard pressed to continue denying this procedure to persons that wish to have it in the future because of this precedent! For a complete manuscript of the court's decision, it has been uploaded to Dr. Husted's site at: http://www.johnhustedmd.com/JohnsonMemorandumOpinion.pdf

What does this mean for ME?  It means I'm gonna get new siding on my house!  Yes, I SHOULD be able to get reimbursed for what I spent paying for surgery myself in Mexico.  We shall see. Stay tuned!
For many more details, feel free to visit my profile!

That's pretty fantastic! I love to see a corporate pig-type company get its rear paddled. You did the work, but a lot of folks will benefit from it! Good going! Nancy

Just wanted to say great work and congrats!  :D  Right now my insurance company has a exclusion on all WLS methods and I am a current state employee who has BCBS of KS.  I think this helps all of us, because the reason most times there are exclusions is because they rule it as investigational or experimental.  I am going to send this to my local legislatures, because I am fighting to get this exclusion dropped from all state health plans.