Just been denied

[myturnow 0]

I have been denied. bcbs ma. my bmi was 37.5 directly after 6 mo of supervised diet. and on its way back up.. I really thought I would get my band soon... now I am starting an appeal process.. my dr.office sending me papers to fill out .. they have an atty that works for my case no extra charge.. I am nervous.. I have asthma, my blood pressure keeps climbing , ostieoarthritis in both knees... If those arent co-morbidites.. it is just a matter of time.. feeling full is my secret shame.. (no so secret to look at me) but I don't know whats ahead .. any wisdom out there friends.. thanks myturnow...donnaco

[tonya66 13]

Hang in there and don't give up!!!! What insurance do you have?

[myturnow 0]

My ins. denied me.. obesity law said they cant help me.. so I am going to file a new claim.. I know I have put on weight since my first one.. so I will have my dr. write me a new letter and re-weigh me.. I know I am close.. maybe if I wear my shoes, my heavy pants.. change in my pocket and after xmas. I am sure to be at 40 bmi.. I know it sounds bad but they will cover it then and I am so close...myturnow donnaco

[marjon9 6]

I hear Baklava helps

[threebeauties 0]

good luck having change in your pockets after Christmas, LOL

I have bcbs of MA as well. My bmi was 39 and I was diagnosed with sleep apnea. I was approved without any problems.

I can't imagine why you werent approved???? I didn't even prove my unsuccesful attempts at weight loss in the past.

Good luck, keep trying.

[Kat817 19]

Appeal it on your own the first time I was told----send in any new info...including weight prior to 6 month program, and since it is going up, whatit is since the program ended. Include any and all paperwork from all Dr.s---if you ever use an ortho Dr. for your arthritis---get the paperwork from him, ask for a letter from him. Anything that way include it. My second appeal went in with 52 pieces of paper!

They said then if it is denied a 2nd time, to go with an attorney. And if you have letters of reference from your Dr.'s I guess you ask for attorney fees....

I didn't know about the last of this, and got impatient, and went self pay after being denied. But I was told the turn over rate once you continue with the appeals is HIGH!!! It is almost like they say no just to see if you will go away and leave them alone, and when that doesn't happen, they actually sit down and have a look at it.

Several people on here have kept copies of the letters they used for appeal. Put out a couple of threads, and see what kind of help they can give you.

Other than that, many have used medical credit accounts to go self pay, others have refinanced their homes....there are several ways if you end up self paying...granted, none of them cheap!

Best of Luck to you!!! Hope you get good response. If it is slow, be sure to bump up your thread at different times of the day to get it seen by members who are working, or different things at different times of the day!

Kat

[Big girl banded 0]

I hear Baklava helps

:pound: That laugh was good for my soul Thanks

[flabuless 18]

Myturnnow! Dont give up....Keep persisting...someone has got to listen. Its your life that hangs in the balance...

becky

[TracyinKS 7]

Blue Cross Blue Shield as a company has a written exclusion, BUT.. talk to your HR/Benefits person and as for the SPD (Plan Document) if they don't know what your talking about ask them to go to Corporate, and find out if WLS is covered.

Our company is switching to BCBS in 2007, and after a chance conversation with our head hauncho.. I found out that we have a PROVISION for WLS, which over-rides BCBS exclusion policy.

[myturnow 0]

well, now the surgeons office tells me my TH4 is out of bounds for the approval.. so my plan is to work with my pcp to get that straightened out.. in the mean time I am so fat I cant hardly stand myself... I need to proceed and get approval.. but the emotional cost is pretty high.. at first I was taking 1&1/2 pill synthroid. that was too much..so I backed it off to 1pill then that is still to much. so I stopped it for a while??? i need to have the blood test ran asap.. does this make sence to anyone else??? It seems you have to be totally proactive and educated about your meds and the what if's or you get lost in the shuffle..:nervous thanks for your suggestions and support.. donnaco

[myturnow 0]

LaJuanna, I have been in that spot.. just before the holidays.. and so I have eaten and enjoyed the season.. now I should be about 40 bmi.. and the thyroid issue has reared its ugly head.. and I am starting to panic.. now I am worse than I started and the band still seems out of my reach.. my clothes are tight.. and I am depressed as hell... be careful.. I didn't even think I might end up not getting it.. food for thought... myturnow..donnaco

[MiniPearl#2 0]

LaJuanna, I have been in that spot.. just before the holidays.. and so I have eaten and enjoyed the season.. now I should be about 40 bmi.. and the thyroid issue has reared its ugly head.. and I am starting to panic.. now I am worse than I started and the band still seems out of my reach.. my clothes are tight.. and I am depressed as hell... be careful.. I didn't even think I might end up not getting it.. food for thought... myturnow..donnaco

:party: I tell you what I'm tired it seems all the time, I still see at least 6 months ahead of me before I get mine. I can bearly breathe I had a tummytuck in2005 and my stomach is flat but full to the max, Then now promise you dont laugh, my sides blew out and l now have arm rests for my arms to rest on and I had small legs before tummytuck now there getting fat. Had implants in 99 ones been busted for 2 years, gotta get that fixed. Im just wonder if Im worth all this money to fix me up? I feel guilty cause I could spend it on kids, Sooooooooooooooo When you start haveing a bad day just think of me with a blowed out tit, and a flat tummy with sides so big now I can honestly use them for arm rest and heck a waist lol I think its under my tits, and if my hips get any bigger Ill just be able to reach over my shoulder to wipe my butt. Just picture that a while. lol :heh:

[MommyMayhem 0]

I hear Baklava helps

lol I second that!