Insurance Denial

Guess it's high time I get involved in this forum!  I didn't even know there was a specific Washington Forum group.  I've been only on the general forum's all over the place - So I'm a little slow! 

Well my insurance company (Boeing Traditional through Blue Cross/Blue Shield - Regence) just denied me.  They need more information.  My 100 pound documented weight loss with weigh****chers 4 years ago wasn't good enough.  After all....I gained it all back plus more after keeping it off for two plus years.  Five doctors supporting letters weren't good enough either. 

I have to have 12 months fully documented dieting and exercising through a liscensed M.D.  My doctors notes over the past few years of attempts and failures weren't good enough either, because I had weight gain during that time! 

After hiding and crying under my blankies for a day - I've now gotten blazing mad and I'll be darned if I will let this lousey insurance company win!  They don't care about saving lifes!  All they care about is the almight $$$$. 

I'm going to apeal and fight them every step of the way and get them to pay in the end!!!

I have Dr. Oh's office sending in 29 more pages of doctor's notes, I have my insurance company sending me a letter (and to Dr. Oh) stating the exact insurance requirements, and I'm seeing my PCP this week to start the 12 months required dieting documentation with my doctor.

If any of you have any suggestions or comments on how to help me achieve this worthy goal - they would be most appreciated......or  if you know of any way to speed up this process

Thank you so very, very much,

ragadolly

Don't give up just find out exactly what they want. I was denied twice because I didn't have the actual doctors chart notes of weights for the last five years. BCBS can be a real stickler for details but once you make them happy it should sail thru easily. Just stick with it!

I agree with the above comment, find out EXACTLY what they want. Make sure your surgeon's office and your pcp have a copy of that. I gave my pcp a copy and he made sure that he documented exactly what my insucance company wanted.
Unfortunately most of us are all to familiar with the crappy insurance companies and their BS. Make sure they pay!

While my insurance did not want copies of my food logs... My nut told me there are insurance companies that do.  I agree with the above posters... talk you to your insurance company and if possible get what they need for documentation of your 12 month diet in writing. Also I am not sure when your benifit year starts and stops... but if the a new year starts in January.. make sure that nothing has changed.

Good luck with your fight with your insurance company!

Helen

I'm so sorry this happened to you.  I know that they just changed the requirements recently.  Used to be all you needed was Dr. documentation of being 100 pounds or more overweight for 5 years. 

Absolutely appeal.  Just because those are their requirements doesn't mean they can't change their mind, if necessary.

Good luck to you and keep us posted.

Wow - good luck with your appeals. I was very surprised to read this, cuz I have Blue Shield/Blue Cross, too, and they approved without all that. I had a physical (on my own, not because they asked) done before, and I had to see a psychiatrist and a nutritionist, plus my surgeon sent me to a sleep disorder doctor, but that was it. I started mid-April and had my surgery 5/20. Maybe speaking with someone in your HR dept - the benefits person - might help. May have something to do with how they have their plan set up, and perhaps there is something that benefits person can do to help.

Keep us posted.

I'm right there with you!  We switched to Traditional specifically because it covered WLS and Selections had an exclusion.  I was so upset to find out they changed the requirements the day we switched over.  So now I'm 3 months into the 12 month "medically supervised diet".  I'm hoping that by the time my 12 months is up, they will have decided to start covering VSG.  Good luck with your fight.  I didn't have enough documentation to even think about it.  My doc has pretty much ignored the fact that I'm morbidly obese and there are very few notes about my weight.
Sheryl