Question:
I have Premera BSBC insurance with a written exclusion policy for WLS

Is it worth writing an appeal letter? I live in WA state and was wondering if anyone else won the battle with the insurance finally giving the ok? Thank you all.    — pattycakesim (posted on June 9, 2004)

June 9, 2004
Patty, Unfortunately, a lot of us in the beautiful Pacific NW end up self-paying for this very type of issue. I would recommend you check out the insurers link at the top of the page, and see if you can find anyone else who has your specific coverage. Also, you can contact www.obesitylawyer.com and www.obesitylaw.com and ask them if they feel like it's worth a fight. For me, we decided to go self-pay - I didn't have the time to waste, I was a heart attack waiting to happen. It was kind of cool basically side stepping the insurance issues that way, too. For my surgery, travel, everything - my open BPD/DS with appendix and gallbladder removal in Alcoy, Spain with Dr. Aniceto Baltasar was $15,800. Let me know if I can help at all, okay? Blessings, dina
   — Dina McBride

June 9, 2004
Dina, I went to a support group while I was doing my research on WLS. While I was there one of the ladies, todl me to be prepared for a denial, but don't giv up. She then gave me this weba address www.obesitylaw.com I went to the website and then fiolled out their form...the inturn sent me a packet of information. After a couple of days, Kelly Brown and attorney from the firm (her husband started it after what he had to go through to get approval for WLS). I spoke with Kelly for about an half an hour (I contacted them because I was denied)after speaking with Kelly , she told me she did not feel I would need to hire her firm. She told me what steps to take and I did. She told me if for some reason I ws still denied to contact her and then we could discuss what she thought would be best. Well, I am happy to say I had Lap Band surgery May 17th. My original denial was on May 5th and on May 12th it was overturned and May 17th, I was in the hospital. Now I am not saying it will be that easy for you, but please give them a try...you have NOTHING to lose (it didn't cost me a thing) and you have everything to gain. I live in Connecticut and the law firm is located in California, read their website, you will see that it very well may not matter where you live, they can more than likely help you. Goo Luck to you and DON'T GIVE UP! Sherry S
   — sac287

June 9, 2004
I think it is always a good idea to write a letter of appeal. The worst they can do is say "no" again. I have begun to think that insurance companies want you to write a letter of appeal (or two) just to make you work for it and to be able to justify it back to whoever at the company. Remember, you are simply dealing with individual people doing their job on the other end and you never know if their job is just to make you jump through a hoop or two. I have gone through this three times with various procedures and all three times I wrote letters of appeal and twice I was approved and once I had to self pay. You just never know. I always felt like they were just sitting on the other end saying "let's see how bad she wants this." :) Plus you always have that for your records later should you need to prove something.. not sure what, but I'm always one for documenting everything.
   — Paula R.

June 10, 2004
I had Premera Blue Cross here in Washington, and over 4 years ago, I hit a brick wall with them. Their exclusion at that time was ironclad, and I have no reason to think it is any different now. I had to self pay, but fortunately that was before the stock market crashed, and wiped us out pretty much financially. So, at least I was able to spend some of that money before it evaporated. Obesitylaw wouldn't even answer my questions regarding Premera...as I guess they couldn't do anything with them either. I hope you find a way. Regards~ Jacque
   — Statuesque