DENIED - What? How? Ug? Wish this were a dream!

Well, I really wish that I was typing "I Am Approved".  I just kep****ching the board & was so happy every time I saw someone type that in (I'm still happy for you all!!!).  I was sure I was next. No such luck.

I have Highmark Blue Cross Blue Shield (PA)--I rcv'd a call today from the financial director at my surgns. office stating that she rcv'd a call that I was "denied" because I didn't meet the "sixth month criteria required by my policy".  She was as shocked as I was.  In fact, she thinks it is a mistake (I guess I am more cynical about insurance companies...??).

My policy requires " cumulative total of 6 months or longer" (so it doesn't have to be consecutive month after month)"....so, they got a 39 page fax that included medical documentation (and one heck of a letter from my PCP) from 7/23/2007 through 9/2/2008.  That's 14 months (I exceeded their requirement by 8 months).  Still, denied.  What?  I am baffled.

So, Eloise (the financial director) sent a fax back to them with the medical documentation again and cited the new "case number" they gave her---and pointed out to them that I, in fact, had 14 months.  She thinks that they said that I only had from 7/23/2007 to 9/2/2007---instead of 9/2/2008--she said that they made an error & thought it was all in one year.  I  really, truly hope & pray that is all this is.

My insurance is under my husband's employer (CSX Railroad--he is an Remote Control Operator/Engineer and has been there about 6-7 years)...and our insurance is otherwise really great. I just assumed that after having three babies and only paying a total of $15.00 in co-pays, plus all the other benefits we are blessed to have w/his job, that this would be approved.  My husband was so mad (he has watched me battle this & try so, so hard to lose this weight on my own--I have comorbids of insulin resistance from PCOS, osteo arthritis from being so active & carrying the extra weight -my BMI is 43--I am 5'8" & weigh 275)  that he called the insurance company himself.  The representative was really nice to him, but told him that she needed to talk to me (HIPPA issues) directly.  So, he got me & I talked to her.  She had been the rep that I had talked to about 5 times over the past two weeks when I called to check on the status.  She was really nice & said that she was going to send an email to the person handling it & that she would check on it for me. 

So, hopefully, tomorrow I will have one of two things....first, and most hopefully, I will get a phone call from Eloise saying, "You are approved--they got the dates on the med recs wrong & you are good to go..."....or, I will get a call saying, "You simply need one more visit to your PCP & you will meet the criteria"....I don't know why I would need anymore than I have done, but, still, I am hoping for any good news.

Tough day.....had to sneak into the closet where I cried my eyes out so my kids wouldn't see mommy sad....they are all three under 6 years old & wouldn't understand.....I just want to be healthy & able to keep up with them.....and be around to see them grow up....

Thanks for letting me vent....I'd love to hear your advice/comments....

 Sounds like your insurance just screwed up the dates. If you still get denied, chin up, just type up a little letter stating that you were denied for not doing the 6 month diet but you in fact have from this date to that. Have your surgeon and PCP provide letters. I don't think you'll have to appeal, sounds like a simple mistake. But if that's your only reason for denial it's easily remedied. Best of luck. If you want to see insurance woos read my profile lol. 

Thanks...I am hoping that's the case...it's 2:20 a.m. and I am exhausted about this, but have been up typing letters & just faxed a 4 page letter to my insurance company & cc'd it to the financial manager at my surgns. office....they should have it on their desks in the morning. 

I just read your profile & I am feeling better about my insurance woes. Like you, I am a "worrier" (aka up at 2:30am on the OH website....).....but, as you know, being a mom there is more in this surgery than just looking like a super model.  I really want to be around, healthy & active for my kids (I have three under the age of 6)...although I am not opposed to looking like a super model, too...:)......I just really feel like I am suppos'd to do this....keep your fingers crossed for me & I will do the same for you!!

Thanks again for posting.....