Friggin denied again!!

[warrior68 16]

I'mso sick of this crap with BlueCross Blue shield. When I first went in to my surgeon the receptionist, and the doctor were both like, "Wow you have great Insurance, approval will be easy, they approve everyone". Three denial letters latter here I sit. BlueCross has these Medical Directors that make all the decisions regarding surgery, but the medical directors will not speak to policy holders. How can a person make life altering decisions on my behalf without even speaking to me??!!! After the second denial I had a sudden loss of vision, my BP went up to 190 over 110, and sugar number were through the roof, and I had four more meds added to my daily pile of pills. I go back to my surgeon who tells me, well now they have to approve you with all that just happened.

Well I just got my third denial letter today, the reason this time, the sleeve is still considered by BlueCross BlueSield to be experimental.

I have contacted my Legislators, and Senators regarding Health care laws and medical directors that are not accessible to policy holders, but that was weeks ago. I just send BCBS a email explaining that I feel they are trying to kill me, rather than pay for the surgery, and I will follow up with a call on Monday.

I have no clue what else to do, I guess I'll just keep taking daily meds and getting sicker and sicker, and hope that I can get approved before I end up having a friggin heart attack.

Sorry, just had to vent.

[PlannerGirl 3]

I'mso sick of this crap with BlueCross Blue shield. When I first went in to my surgeon the receptionist, and the doctor were both like, "Wow you have great Insurance, approval will be easy, they approve everyone". Three denial letters latter here I sit. BlueCross has these Medical Directors that make all the decisions regarding surgery, but the medical directors will not speak to policy holders. How can a person make life altering decisions on my behalf without even speaking to me??!!! After the second denial I had a sudden loss of vision, my BP went up to 190 over 110, and sugar number were through the roof, and I had four more meds added to my daily pile of pills. I go back to my surgeon who tells me, well now they have to approve you with all that just happened.

Well I just got my third denial letter today, the reason this time, the sleeve is still considered by BlueCross BlueSield to be experimental.

I have contacted my Legislators, and Senators regarding Health care laws and medical directors that are not accessible to policy holders, but that was weeks ago. I just send BCBS a email explaining that I feel they are trying to kill me, rather than pay for the surgery, and I will follow up with a call on Monday.

I have no clue what else to do, I guess I'll just keep taking daily meds and getting sicker and sicker, and hope that I can get approved before I end up having a friggin heart attack.

Sorry, just had to vent.

When i thought I might be denied, the coordinator at my doc's office suggested the lawyers at obesitylaw.com . I called them and spoke to them and they gave me a ton of advice and didn't charge me. It's a husband and wife team, and I was very impressed. They charge a flat fee between $600 and $1200, which I don't think sounds outrageous and their track record is unbelievable.

It sounds to me like you could really use an advocate. Look at their website, there's a lot of articles he's written. The insurance company needs to be taken to task. Don't let them get away with treating people so callously.

Best wishes, and I'll be sending all my good luck vibes your way.

[Was a humpty dumpty 35]

Keep fighting and don't give up.

[NBflo Girl 2]

I don't know where you are from but there is an appeal process to go thru and each appeal is reviewed by a different doc.. get your doctor to send in a very strong letter to stress all of your co-morbitities.. if that doesn't help, go to your State Insurance Department and se if they have an appeal process you can go thru...

[iegal 460]

Stupid question but did you have your general practioner also write a letter?

I understand that some divisions of BCBS do approve the sleeve now. Kaiser approves the sleeve. Post above about paying a fee to lawyers sounds good. Best wishes and keep us in the loop.

[warrior68 16]

Thanks for all the posts, I will definitely check out that attorneys website. I did have my Primary care Physician write letters to BCBS, three of them. MY PCP stated all my Conditions, and said that he believed that WLS was the best option I have at living a long healthy life. In each letter he wrote down my weights at different dates over the years- I have always been able to diet, lose 40 to 80 lbs quickly, but then it comes back with even more.

When I emailed BCBS yesterday, because there customer service was not open to receive calls a few of the things I mentioned in the email were.

They had medical proof that I was headed towards a hear attack, or stroke, yet they denied me for a procedure stating not med necessary, and that shortly after that denial I damn near did have a heart attack or stroke, with a temp loss of vision, elevated BP and sugar levels. Now they have more med proof that I need the surgery and they still wont cover it. I pointed out in the email that with all that is going on in this country with health how would it look for BCBS if I were to contact all my local news channels and explain how my insurance company is denying me a med procedure that will save my life. I further went on to explain that as of the close of business on Monday if have still been denied access to this "Medical Director" that is denying me stating they only talk to Doctors, well they will then have two types of people Medical Directors speak to, Attorneys, and Doctors.

I was so pissed yesterday when I received that letter, I haven't been that mad in a long time, and of course I had nobody to vent to because I haven't told anyone I'm having surgery. This has been a very long process / fight for me, and each time I see the Surgeon and he tells me that, "dont worry I'm gonna get you approved" I get so excited, and feel like I'm on top of the world! Without fail A few weeks later, wham the insurance company sends another letter stating that they are going to cheap out and deny my surgery. I have asked them on the phone, if they would have preferred that when I damn near had the hart attack, that I would have just died? No surgery cost, no meds for life, they win, right?

Sorry, I'm rambling on and on again, I must still be more mad than I thought I was when I woke up.

Thank you everyone for your support and great post.

[KabinKitty 11]

Thanks for all the posts, I will definitely check out that attorneys website. I did have my Primary care Physician write letters to BCBS, three of them. MY PCP stated all my Conditions, and said that he believed that WLS was the best option I have at living a long healthy life. In each letter he wrote down my weights at different dates over the years- I have always been able to diet, lose 40 to 80 lbs quickly, but then it comes back with even more.

When I emailed BCBS yesterday, because there customer service was not open to receive calls a few of the things I mentioned in the email were.

They had medical proof that I was headed towards a hear attack, or stroke, yet they denied me for a procedure stating not med necessary, and that shortly after that denial I damn near did have a heart attack or stroke, with a temp loss of vision, elevated BP and sugar levels. Now they have more med proof that I need the surgery and they still wont cover it. I pointed out in the email that with all that is going on in this country with health how would it look for BCBS if I were to contact all my local news channels and explain how my insurance company is denying me a med procedure that will save my life. I further went on to explain that as of the close of business on Monday if have still been denied access to this "Medical Director" that is denying me stating they only talk to Doctors, well they will then have two types of people Medical Directors speak to, Attorneys, and Doctors.

I was so pissed yesterday when I received that letter, I haven't been that mad in a long time, and of course I had nobody to vent to because I haven't told anyone I'm having surgery. This has been a very long process / fight for me, and each time I see the Surgeon and he tells me that, "dont worry I'm gonna get you approved" I get so excited, and feel like I'm on top of the world! Without fail A few weeks later, wham the insurance company sends another letter stating that they are going to cheap out and deny my surgery. I have asked them on the phone, if they would have preferred that when I damn near had the hart attack, that I would have just died? No surgery cost, no meds for life, they win, right?

Sorry, I'm rambling on and on again, I must still be more mad than I thought I was when I woke up.

Thank you everyone for your support and great post.

[MRSKOUBiK 27]

I'm sorry for all this trouble.

I hope and pray that something gets figured out for you soon!