Question:
BC/BS - Traditional Plan - 1 yr of documented weight loss

I am having a VERY difficult time here with BC/BS trad. plan. They are telling me that I HAVE to have a "consistant" 1 yr. of documented weight loss history before they will consider giving me my clearance for surgery. I have had all my other tests done (I started my surgery "plight" last September with my initial trip to BTC in Ann Arbor after waiting 6 months because of changing to BC/BS after other insurance carrier PHP flatly denied me!!) and while they put me through the ringer with endless testing ..psych. eval, pulmonary, and cardio...all of which SCREAMS I need this surgery IMMEDIATELY (my BMI is 88 for godsake!!) I complete all the needed testing only to then find out that because it has been over 3 years since I have worked "faithfully" with a PCP for my weight issues - they denied me immediate surgery. Now I find out that there is a time limit that they will accept all my testing as "valid". So, here I sit trying Weight Watchers AGAIN...all the while losing great physical ground, not to mention all the added mental stress and strain of this situation. Has anyone else encountered anything similar? I called BTC yesterday, and they throw this hot potatoe of a topic back in my lap - telling me there is NOTHING they can do, their hands are tied due to my insurance carrier. I am at my wits end here, and feel that this is all a stalling technique for them to simply wait me out, waiting for me to simply die!!! There has to be a better way somewhere, somehow. ANY SUGGESTIONS ??    — Penelope R. (posted on February 28, 2001)

February 27, 2001
Penelope: This is something I'm also worried about. Unlike you, I have no efforts with a PCP and I have such a block against things like weight watchers and I'm really worried that it's going to cause them to deny me. It does seem like with your BMI they shouldn't be waiting for a bunch more failures before approval. This could turn into a medical emergency. It might be time to think about talking to a lawyer. I'm just starting the nightmare myself so I may not be the best person to give advice. You might also try another surgeon. It seems like some of them work harder with insurance than others. Please keep us informed. Maybe if enough of us have these problems we can start a class action. Your situation has me feeling activist. We're here for you no matter what.
   — kcanges

May 28, 2005
I totally understand where you are coming from I have been fighting with insurance as well I have BC/BS of Illinois and the also told me I had to have a 1 year of documentation of weight loss, after it was proven to be medically necessary. I have a bmi of 69.24, so i know how you feel and i am ready to scream, isn't this why we pay such high insurance costs for us.....keep fighting i know it will happen for you.....Ronda
   — Ronda H.