denied the machine

Well, I just got a call from Lencare about my CPAP Machine. BCBS denied me.   But they said that they will send me the denial with my appeals paperwork. And that the only reason I was denied was b/c my husbands ins policy has a "preexisting condition clause" in it.  If my appeal is denied then I have to wait until November st for the CPAP.  Which for me means moooore waiting.  :(     I guess Nov. isn't that far away, but right now it seems like ages and makes me hopes for losing a lot by Christmas a non-existent possibility. I am bumming out BIG time right now. 

 

 

Oh Vicki that blows I am so sorry to hear that.Try to hang in there.

Hi Vicki,      Did you know you had sleep apnea? How can it be pre-exsisting if you didn't know? Do you need the c-pap machine before you can have your surgery? Good luck in your appeals process, if I can help...let me know.                                                                  Judy

Hi Vicki, Lots of insurance companies deny things first time out, so be sure to appeal it when you get the paperwork and as was said by the other person, how would you have known it was pre-existing if you'd never been tested for sleep apenea before, these insurance companies have way too much power, but perhaps in the appeal process you will win, if not, as you said November is not all that far off, but I can understand the being bummed part.  Hang tough girl!

I can certainly relate to issue with BCBS, I was approved for my surgery in November 2006 and so I went and had all the prelim tests - when I was finally done the tests and waiting for my surgery date, BCBS denied me (feb 07) and I had to fight them tooth and nail.  I finally got my approval 4 months later and the waiting we just horrible.  I appealed their decision and just in case that wasn't going to end up in my favor, I found out about www.obesitylaw.com and contacted them as well.  I was just about to hire them, but I was blessed with a good appeal and was approved.  (they tried to say because my bmi was 60 that surgery would be experimental for me and that there was not enough evidence to support it would help me - thank God the appeals doctor told them there was NO reason my bmi should stop my surgery. I should also say that the employee benefits manager for my husbands company had a huge hand in helping me - she was great!   Get on the phone with BCBS, DOCUMENT EVERY SINGLE NAME, DATE, TIME OF EVERY PHONE CALL - GET FULL NAMES, PHONE EXTENSIONS, THEIR SUPERVISORS NAMES, AND IF POSSIBLE RECORD YOUR PHONE CALLS!!!  Get on the phone with your husbands employee benefits manager and document the same as with BCBS. In the meantime, go online and see if there are any agencies that can donate or lend out a cpap machine.  check out www.newjersey.craigslist.org  (i think that's the address)  they also have a sight just for north jersey and one for south jersey.  (i did a search using "cpap" and found 3 on the south jersey site and one was only $250.  contact your local churches and volunteer services (the ones that help with paying bills, supplying food, etc..) lot's of times, people donate things to these organizations to help others that are in need. God bless, and may His peace be with you... briggie ^i^  [email protected]  just in case you want to chat....  www.jehovahroi.wordpress.com  my blog, just in case you want to ...

I didnt even so much as think I had sleep apnea until March of this year.  And, didnt think it was true until the end of April after my sleep tests.  I am hoping I can find a way to work around this.

My only thing is even if I get a CPAP machine from some place else will it count towards my surgery and how would I know the settings?  I have a lot of findoing out to do still. 

I truly appreciate everyones kind words!

GREAT NEWS!!!!  I just got a call back from Lencare (my cpcp people!)  and the insurance lady changed her mind!!!!!!!!!!!!  I AM APPROVED!!!!!!!!!!!!!  I AM APPROVED!!!!! MY MACHINE COMES TOMORROW!!!!!!!!  YEA!!!!!!!!!!!!!!!!  :)

Sorry, everyone I am just SOOO happy!!  Thank you ALL for yout houghts and prayers!!

The insurance lady (Fatima, I will cherish the name.)  called Lencare this AM and said she thought about me all weekend and decided to override it and approve me!!!  How awesome is that!!!!  I am soo happy!! Back on track!!    Back to calling Barix more often to get things MOVING!!!! 

Thank you thank you thank you!!!

 Praise God - He has control over all things.  How awesome for you. I will keep Fatima in my prayers and ask God to bless her. Put God first in all things and He will guide and direct your path, and those you meet along the way. God Bless, Briggie

THANK YOU!

OK.  VIC    YOU HAD THE SLEEP STUDY DONE, AND THEY SAY YOU NEED THE MACHINE.   WHEN  YOU GET THIS PAPER WORK,  FILL OUT YOUR PART AND HAVE YOU FAMILY OR YOUR PULMANARY DOCTOR WRTE A LETTER AND ATTACHED IT.    IF THEY KNOW YOU HAVE THE ILLNESS AND THEY APPROVED YOU GOING FOR THE TEST,  THAN THEY HAVE TO RESPECT THE RESULTZ.   THAT WOULD BE LIKE "YES YOU CAN HAVE YOUR BAND OPERATION" BUT WE ARE NOT PAYING FOR ANY FILLS.   WITH FILLS THE OPERATION DOSE NOT WORK. IT 'S BOGESS.....................  SO YOU DOCTOR WILL KNOW WHAT TO WRITE. LIKE I HOPE YOU WILL BE RESPONSIBALE WHEN SHE DIES IN HER SLEEP,  ARE YOU READY TO PAY FOR SOMEONE TO MIND HER CHILDREN. LET US KNOW HOW YOU MAKE OUT.   YOU MIGHT WANT TO  REPORT THAT TO AN INS COMISSION.   EVERY STATE HAS ONE.   YOU LET THEM KNOW WHAT THEY ARE DOING. TAKE CARE MY FRIEND. BRIDGET  K.