BCBS Alabama Denied Denied Denied !!!!!!!!!!

I recieved my letter on Tuesday. I am so dang mad. The letter said that I did not meet the medical criteria guidelines. That there was no documentation of morbid obesity for the last 3 years documented in the medical records and that there was no documentation of participation in a medically supervised weight loss program for six consecutive months with at least one attempt occurring during the six months prior to surgery. I had gathered 4 years of documentation with height and weight on everything. I have been morbidly obese for 10+ years. I participated in Curves last year...with physician documentation. I am sooooo mad. I don't mind doing ANOTHER attempt ....diet or whatever, but for them to say that I don't meet the 3 year morbid obesity..that's bull crap. I don't know what to do from here. If anyone has suggestions please reply. Thanks, Bethg

APPEAL APPEAL APPEAL!! I have heard that some insurance companies will automatically deny the first letter,this was the first right? It sounds like they were looking for excuses. Persistance works best. Also I have heard Gary Viscio works wonders. Wouldn't hurt to shoot him off an email. Best of Luck, Kristey

Beth, Don't give up. I just won my second appeal for RNY and owe it to the help of Gary Viscio. His web site has a lot of good information obesitylawyers.com GOOD LUCK! Krista

beth i am very sorry for your disappointment,appeal it. i am very scared of the same thing happening too me. i went yesterday to view my medical records from 2001 thru 2003 i notice that all my diagnosis are listed except morbidly obese. i have been morbidly obese since i was 16 and the doctor i was using then know i am. on some of my doctor visits he documented in his notes that i am morbidly obese, height and weight , but it was not printed under my diagnosis. i think the insurance co want it to be written under diagnosis, i have been seeing my new doctor since nov 2003 and he has all my diagnosis written out each visit whi*****ludes morbidly obese...

I went to my PCP yesterday. I am not sure what I am going to do about the denial, but I did have her start at zero with me. She ordered a dietician consult and I am going to start weigh****chers...AGAIN, since it has been years since I used them. I will do weigh****chers with my PCP supervision and monthly visits to my PCP for progress notes and weight and height and documentation...morbidly obese at each visit. I will do this for 6 months and then resubmit. I am also going to keep an exercise log with my walking, ect. My PCP stated that she would write a letter when we resubmit stating that I have been morbidly obese since she has been my PCP...we will submit pictures also if necessary, since all my medical records didn't have morbidly obese stated on them...even though they do have my height and weight listed..which WELL QUALIFIES me for BMI 46 and higher...which is morbidly obese. This is just another kicker with the insurance to try not to pay. I am well motivated...I will do this physician monitored dieting...but it makes me madder than heck because I had already done Curves with her documentation and my height and weight are well documented throughout the medical records. It makes me mad, mad, mad. Thanks for your support..I hope that you have good luck with approval. If you have to do the diet thing...maybe you could do weigh****chers too...we could do it together and monitor our progress. I don't usually lose a lot with weigh****chers...but I will do anything to prove i am trying and committed.

::: sneaking in ::: Be sure that your insurance will accept Weigh****chers as a valid diet. Mine would not, I had to have my PCP write in his clinical notes (the notes he takes at all my visits) what specifically we talked about during my months visits on the 6-month supervised diet. He wrote things like, "Discussed low-fat, low-cal diet..." etc. He also noted monthly any weight change, whether I gained or loss and made a note. One of them was, "Patient gained 8 pounds because she is unable to exercise strenously due to osteoarthritis in back and hip." My PCP gave me diet sheets from his own office and wrote down the particular Doctor's diet he put me on. Just make sure whoever is supervising the diet takes very good clinical notes. Good luck.

Hey Shayna, Thanks for the info. According to BCBS of Alabama they accept weigh****chers with Physician supervision and documentation. I am also going to appeal while doing this. They claim that I don't have 3 years of documented history of morbid obesity which is bull so I am going to let the lawyer handle it. Thanks so much. I will pass the criteria on to my m.d. for documentation. I had already discussed it with her, but I will keep up with her note taking to make sure we cover all bases. Thanks again... Beth

FIGHT Don't give up. Call the Insurance company and ask them what they want. Explain that you feel you have given them enough documention. They might just want you to do the 6 months of dieting under our PCP. When was the last time you where under your PCP care for a diet? I have heard of insurance companies losing or claiming they did not get all the information. Best of luck Donna

Thanks Donna, I am starting a 6 month PCP supervised diet. I had done a weight loss program and went through Curves, but this wasn't enough for them. The other thing was the fact that even though my height and weight are listed it wasn't documented morbidly obese in the medical records. It makes me mad because if you do the math my BMI proves morbidly obese. Thanks for the reply...I will keep posting to let you guys know how it is going.

Beth, I was just fixing to write this very same letter!!! I was denied for the second time with BC/BS of Alabama!! The first denial said they needed documentation that I have been obese for 3 years and proof I had been trying to diet for the 6 months just like you. My PCP wrote a detailed letter stating I have been obese for 12 years and the different diets I have been on which all failed. NOW, they are saying the exact same letter they sent you but they are saying they will NOT accept a Doctors letter they want 3 years of medical records and the diet has to be in the medical record. Well, wish they had told me that 7 months ago when this all started. They said we will accept WW or Jenny Craig or any letter you could get. Any letter but my doctor????? Yeah right!! I am going to the doctor Monday and start a 6 mo. diet also . My surgeon thought I could get a lawyer but I don't want to waste any more time fighting them if in the end I will still have to give them 6 more months of my life??? What do they think we can do in 6 months that we have not done in the past 20 years????? Any helpful hints??? Karen