Denied again need help

I have BCBS of Alabama and can't tell you how much I am not loving them!! After being denied the last time because of lack of documentation and going to Doctor for 6 months. I did all of this and just got denied again. On the phone they told me my BMI was not over 40 in O3, and 04. Which I am sure it was. Also, said there was not documentation of going to doctor for 6 months. I DID!!!!! I just got the letter and it only states no documentation of 6 months and no physical from my surgeon which I also did!!! What are they looking for it to say from my doctor??????????????? I sent them 3 years of my medical file. Anyone with a suggestion what I do now? Thanks, Karen

Personally, I would get an attorney - someone like Gary V. Otherwise, you can always send it to them again and this time put the information they say they're missing right on top. Do you know what your surgeon's office is sending in and in what order? I have'nt had a great experience with my surgeons office staff so I'm on them like white on rice. I make sure I see EVERYTHING they send to my insurance company. I get on their nerves and I know they don't like me much but I don't care . This is not a popularity contest. Plus I figure which is worse - them not liking me or me getting them to do what I want so I have a better life..? The latter works for me. Good luck to you.

Karen, They are usually looking for 5 years of medical history showing that you have been mobidly obese. And maybe that you can walk on water and play the banjo at the same time . I know it's frustrating but stay with it. It will be worth it in the end. Hugs, Ronna

Well since most of us can't play banjo or walk on water where does that leave us? ROFLMAO Your choice of words cracked me up.. Thanks

I am in the process of appeal too! I was also told by BC/BS that because my BMI was not 40 or more for 5 consecutive years (although it was for maybe 15 of my 30 years of life!). My doctor wrote a letter and faxed it. I wrote a letter and faxed it. I also got a complete weight history for the past 9 years from my ob/gyn (they never let me get out of being weighed) which showed I was morbidly obese, lost weight, then gained it all back plus some. If they want I will just eat whatever I want for the next 5 years, get diabetes and lord knows what else, then they will have no problem paying for it. Does not make sense!! I hate insurance!! We have to put our lives in the hands of someone who is trying to save a buck any way they can. Good luck with your fight! I am not giving up. I will be the biggest pain in the *ss calling them every day! Jenn Y.

I also am insured through BC/BS of Alabama. If you go to their website in the provider area http://www.bcbsal.org/providers/index.cfm you will see a section that says "Guideline and Policies" and then choose "Medical Policies". It will take you to a search screen, where you need to do a search for "morbid obesity." You will then be able to choose a section, which will be the actual policy for WLS. It clearly indicates what must be done to get approval...well...as clearly as an insurance document can make anything. If you print that out and make sure you comply with everything, you may not have as much trouble....its a shot anyhow. I know mine indicates that I need 5 years of documentation of morbid obesity and 6 consecutive months of medical weight loss attempt within the same year as surgery is requested.