Question:
I was denied Insurance coverage from BC/BS.

My contract states ..."No benifits are provided for servces and supplies related to weight reduction programs ( except for surgery for morbid obesity for a life threatening condition.)....I have been taking 3 different meds, a total od 5 pills a day to control my blood presure, which by the way still happens to run about 160/96. Am I crazy, or is B/P a life threatening condition. Is this worth a shot at an appeal. and how do I go sbout it. I have an appt. with my family DR. next week,she is very supportive of this surgery.Sould she write an appeal letter for me, explaig that B/P is life threatening. and also is there anything that I can do as well? Thanks in an advance for your help.    — STAR W. (posted on December 30, 1999)

December 30, 1999
Starr I have BC/BS Federal and was approved without a life threatening condition. My problems were more related to arthritic conditions (ankles, knees, hips plus lower back pain). Appeal, you will never know unless you try and a lot of people on this site have BC/BS and have been approved.
   — kaydeeb16

December 30, 1999
Hi Starr, I also have BC/BS,I was approved very quickly. You need to appeal. Many people get denied the first time, so you must appeal. When I first started this journey I decided that I would probably be denied and I started collecting paper work that could help me fight the insurance industry. The first thing I did was to get a letter from my family doctor stating why he thought this surgery would benefit me. With that letter I contacted every doctor who ever treated me. I mail them a letter explaining what i was looking for and sent them a copy of the letter from my primary Doc. I was so surprised by the out come. I recieved positive letters from everyone, Iam thankful I didn't have to use them. Maybe you can implement the same procedure to help you with your appeal. If I can be of further assistance please e-mail me. Good Luck Donna Shepard
   — Donna S.

December 30, 1999
STAR, PLEASE APPEAL AND YES, MOST DEFINATELY HAVE YOUR PRIMARY CARE DR. WRITE YOU AND APPEAL LETTER STATING ALL YOUR CO MORBIDITIES AND MAKE SURE SHE/HE MAKES IT A VERY STRONG LETTER. THE WORDS YOU HAD POSTED IN PARENTHESIS IS YOUR OUT. THEY ARE EXACTLY YOUR SAVING GRACE. SO PLEASE GET YOUR PAPERS IN ORDER WITH YOUR DR. AND FIGHT THE INSURANCE COMPANY FOR THE SERVICES THAT YOU HAVE PAID FOR.
   — TERRY L.

December 30, 1999
Hi Star, I have B/C B/S as well. I was approved but, I would definitely suggest that you appeal. A letter from your primary will help. I also have high blood pressure that is very hard to control. I had my primary care write a letter stating all my co-morbidities and that the benefits of the surgery far outweigh the risks. I firmly believe that this helped with my approval. Don't give up!!!! It may take a little more time than expected but, persistence pays off in the end. Good Luck and please let us know what happens.
   — Jodie R.

January 1, 2000
In my state, the "state regulator" is the State Commissioner of Insurance. I was told to definitely send a cc to that office, as they flag such letters and the insurance company has to have an answer back within two weeks with a good explanation as to why it was denied and why it shouldn't be overturned. Hope it works for you.
   — Sandy C.