will help with denials

posted this on the main baords but thought I might post it here as well. check out my profile and if you need help with denials I will do what I can. here is wishing everyone a great day!

I have BCBS PPO of Tenn. and it is an exclusion on my policy is there any way around that? I would love any help or advise I could get I am very discouraged. Thanks, Polly M.

Hey Polly, I was accepted by BC/BS of TN PPO two days ago.

I also have bcbs of TN adn was eventually accpeted after three appeals. But it will depend on which cmpany you work for. Even though they use BCBS many are self insured and have their own exclusions

Anne, Do you work for a large group, I work for a small medical practice and it is an exclusion on my policy. I have every co-morb. to think of and have 3 doctors letters stating that it is medically necessary for me but I was told by BCBS that I was not worth the cost of the surgery to them and that as long as I was on BCBS with this company I would not be having the surgery. to say the least they were very ugly. but Congrats to you keep me posted I will live vicariously through you.

Just a comment: WHY would a MEDICAL practice EXCLUDE WLS surgery in their medical insurance coverage? That makes NO SENSE to me. Oh I get so frustrated hearing about people getting turned down. EVERYONE deserves to get healthy. I had my surgery on 2-13-04 and my insurance STILL has not come through even though they gave a pre-cert. They keep saying they don't have my history or op-notes but my Dr. office claims to have sent it TWICE. Hugs, Beckey

Oh My employer has told me that the surgery is not needed that all I would have to do is push away from the table and I would loose weight, this coming from a man who had Lipo-suction, he is a physician he knows better. But I will not give up I am determined to find away to have this surgery. Thanks, Polly

employers exclude it mainly because it is expensive in the scheme of things, they feel it is not necessary as they dont need it why would you, they believe you caused this problem you should deal with it, or they exclude it because they get a better rate for not including everything under the sun. remember the employers pay a part of the ins. premium usually and the premium they get is for what is covered. I am sure it is a complicated processof they will cover this and they wont cover that. In the end it comes down to they dont understand WLS or its need among the MO population. they dont see the big picture of it saving lives and money for them in the long run. One of the goals of appealing denials must be to educate the ins . co and employer . do that by showing them statistically how the surgery saved both lives and health of patients, most reucing the cost of their currentnlife saving medicines do to the weight loss. If we dont educate them things will never change.