Question:
Partial Denial?I BCBS Florida PPO

My surgeon and I was sent letter after submitting to insurance and it states that : Our medical Review analyst has carefully reviewed the proposed procedure and all documents.Based upon the review,the procedure would not be a covered service under the terms of this contract.The patient is in a pre-existing time frame until Sept.1,2003and will not be eligible until that date for this service. For further consideration at that time please submit1.documentation (office notes) supporing 12 consecutive months of MD. weight loss atempt.This determination should in no way influence a decision to proceed with the treatment or hospitalization.The intent of this letter is to advise that no benfits would be provided under this contract at this time. end of letter.I dont have pre-existing under thier guidelines b/c I havent seen a doctor for atleast 2 years before I had thier policy and thier pre existing is 6 within 6 months before insurance I called and explained this to them and they say they know I dont have pre existing condition but if I had the full 12 months of diet it would be before i had this policy and that would be pre existing I called my state ins. comm. and they said it sounds as though they are playing word games and they want me to follow a complaint and they said they can probably take care of it I already made appeal letter and my Dr. wrote that my life is in danger in his medically neccesary letter and I now have 8 months worth of diet w/ him I was wondering if anyone can give me any advise on if I should send the letter from my doctor along w/ the 8 mths. of diet history and the appeal letter or should I JUST GIVE ALL THE INFO. To my surgeons office and have them re submit this time with 8 month diet and new letter from doctor.sorry so long THANK YOU FOR ANY HELP    — Jade S. (posted on April 15, 2003)

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