Question:
I just called BCBS ,And found out I was denied?

When I filled out my paper work for WLS I even had to add 3 extra pages to cover all the diets I have been on. When I called the insurance.She told me I had to have 18 mon in a row of a diet with a DR. And that since we switched meds it doesn't count .(I was fumin) I am appealing and I was wondering how soon I should get a lawyer involved?    — Autumn (posted on March 27, 2003)

March 27, 2003
Just wanted to let you know my heart aches for you. I don't have an answer but I know you must feel so frustrated and disappointed. I'll keep you in my prayers.
   — Jill E.

March 27, 2003
ok autumn (i just LOVE that name!), first you need to calm down and NOT take this personally. It's way too soon to escalate things by calling a lawyer, IMHO. get your copy of your health plan and carefully study the requirements under which they will pay for WLS. if the 18 month in a row requirement is there, do you have any series of diets you were on for 18 months? have you been seeing your current doctor for at least 18 months? then call BCBS and CALMLY and politely ask them to send you a copy of the appeals process. then follow it to the letter. document everything, make copies of everything, send everything by registered mail with delivery confirmation. keep focused and follow their rules. I know it's frustrating, and it might not work. you still might have to get a lawyer after them. but give their way a try first.
   — Kasey

March 27, 2003
I agree with the previous poster. Read your policy carefully and if you don't see what they're talking about, ask them to show you in your policy (since every company's policy with BCBS can vary depending on how your employer contracted with them)where those requirements are. Ask her to show you where it says that the doctor is not allowed to make changes (ie - meds) to the diet if it doesn't appear that the diet is working. Lastly, relax - you need a calm, clear head to deal with this. Your insurance company obviously covers the surgery which is a lot more than what others have. It's just a matter of jumping through their hoops. It's frustrating, but I'm sure it will be worth it. Remember..."Good things come to those who wait". Good Luck.
   — Carolyn M.

March 30, 2003
Hi autumn, I am with you on this, just got my denial on appeal and they asked for same thing, 6 months of dieting out of the last 12, the fact that I have a 15 year history of dieting didn't appear to be enough. This surgery is not covered expense unless medically necessary so I too am on to the next step and frustrated. Hang in there, we will get there soon!!!
   — sheila F.