Denied!!!!

After waiting for more than 2 months to hear if I had been approved by BC/BS of Alabama they finally told me I had been denied Dec. 30! They said due to lack of documentation!! I need to prove I have been obese for more than 3 years, I need 6 mo. of supervised diet and a physical from surgeon with history which they don't usually do until 2 weeks prior to surgery! They said they have never heard of this before! I am sure I can get proof of my being overweight more than 3 years, and the physical. I am not sure if I have been documented for 6 consecutive months with one month being at least 6 months prior to request for surgery!! I have dieted for 20 years! I submitted all the different diets along with the diet drugs I have used in the past! I am waiting now on my PCP to see if they have any documentation to help of if I have to start from scratch?? How detailed do they expect the PCP to be with this? I have heard of some individuals who just told them what diets they were on and they accepted this! I feel they are just trying to get out of this surgery! Should I write an appeal letter to accompany the other paperwork they are requesting??? sorry soooo long! I want to get it right! Karen

I have already email you. I wanted you to know that I got a call from a representative on Dec 30 also saying I was denied and my letter came in the mail on Jan 5th. First of all they are stalling with this situation. They have to give you an answer in 30 business days. If you waited 2 months that was ridiculous!!! They input my information on Dec 1st and I demanded to know the answer Dec 30th. I called several times a week and email them also. They will lag around with your life if you let them. I'm wondering about your surgeon's office though. They knew the criteria and could have gotten some of that stuff in for you. Getting records from you previous doctors would have proved your weight for the last three years. That was the first I heard about you had to have a physical from surgeon to submit for predetermination to have the surgery. During the last year did you consult with your doctor about your weight? Maybe your PCP can vouche for you dieting. They use to accept a list of diets, but now they don't want to acknowledge these efforts on our part. It really sucks. I know!! We have got caught in the battle, but I refuse to become a causualty. I know people that gain weight to have the surgery and are know skinny!! I t just burns me up that I have struggled with my weight all my life and it almost means nothing!! Jacquis

Jacquis, Sorry to hear you are also having trouble getting approved! I just got my letter yesterday but I have already called my PCP and they are working on the documentation. I really hope I don't have to start with a 6 month diet, my gosh I have been dieting for 20 years!! The surgeons office said they have NEVER been required to do the physical for approval for surgery they always do that 2 wks prior to surgery! I know they are just fishing to stall! Use any excuse they can! But, I am gonna keep trying! Why were you denied? ARe you going to appeal?? Good luck! Karen