Any Success in Petitioning your Plan Administrator?

I have BC/BS Texas PPO. Luckily our plan is employer funded, so I have a little better chance of getting approved, but it will still be a challenge (if at all possible) to move ahead without the 12 Month MD supervised diet -- I have over 4 straight years on WW and all the supporting documentation, but it's pretty much only good for kindling. My question is, has anyone written a letter justifying their case to their Plan Administrators and had success? If so, would you mind sharing your letter? Truth be told, I really wouldn't hesitate to complete the MD diet, but my fear is, if that doesn't work, and my plan addes a flat-out exclusion, I could be at a loss. If you've written and letter you are willing to share, please e-mail me. Thanks! Donna

Hi Donna, I could send you a letter if I have your address. In my situation, the insurance company came up with a diet requirement when they knew they were no longer going to be providing coverage, and tried to use that to stall out the time, so I had to fight to even get the surgery done at all. Because I could show I had been dieting for years and show that studies show dieting does not work, I was finally able to get approved. You can email me if you want a copy of my appeal. Good luck to you.

Dear JH: Would you mind terribly sending me a copy also? I had fought all last year with my former insurance company only to be told there was nothing they would do. We changed to BCBS of IL PPO because they do cover the surgery, but now I am afraid that although I have been under a doctor's care for years trying to lose weight, they will deny me because I have not been there each and every month in the past year, and they will make me wait ANOTHER year. Thank you for considering it, Dawn B. Rock City, IL

Good luck. BCBS of IL are a bunch of jerks. I had nothing but problems with them and then they screwed me at the end by refusing to pay my surgeon after I had my WLS. I paid my surgeon out of pocket as it was well worth every penny. Donna 338/153

Donna, Please read my profile. I had to have a 12 month diet and also have a self-funded insurance plan. After completing 6 of the 12 months, I thought that I would submit and take a chance. I was still denied. My employer stood behind BCBS of IL. I knew that I was going to have to meet the criteria in order to be approved. I had already changed jobs to get this insurance to have it covered. I am so glad that I was persistent and it paid off. I am 10 days out. Be patient and your time will come. Beth