New and Hopefull

[rensan65 0]

Hi everyone,

This is my first posting and I am very optimistic with all the new developments I have been reading regarding Insurance and Lap Band. My company is switching from UHC to Anthem BCBS come Jan. 1st. UHC has flat out denied me and I wasn't aware of the power of appeal until I starting reading everyone’s postings. So far, from the inquires I have made, my new BCBS carrier maybe allowing for the procedure and I am so happy that I am almost in tears! My BMI is 46 and I am only 34yrs old with two little ones that I want to be around for. And last year I was diagnose with Severe sleep Apnea and in recent years I am suffering from all the joint and back pains. I hope BCBS changes my life. :cry

My question is, what should I have ready prior to Jan 1st when I apply for the surgery so that I have the best possible chance in getting accepted as soon as possible? And I know it’s premature, but does anyone have a sample of a successful appeal letter that worked for them?

Any help from anyone one be forever appreciated :help:

RENSAN

[Sue Magoo 71]

Rensan:

You might consider speaking with your human resources department to find out if they have a booklet from the bcbs group yet. It may include notes about exclusions.

I had BCBS in MA and it was really a piece of cake. It was all handled by my surgeon's office. The office staff at my surgeon's office is wonderful!My BMI was just over 50, so there was no question that I needed the procedure. I was fortunate that it was not excluded on our medical policy at work.

Good luck.

Sue

[rensan65 0]

Hello Sue,

Thank you very much for your feedback. I will check with HR. In fact I already e-mailed them.

I forgot to mention that I am in Southern California. I hope I have the sasme luck you did!

Congradulations by the way!

Rensan

[kaninag 35]

BCBS generally requires 6 months of a MD supervised weight loss program, they will also ask for you medical records documenting your ht and weight for the last 3 years, H&P from your surgeon and a signed letter from you stating that you will or do not smoke 8 weeks prior to surgery.

Hope this helps.

I am actually nearing my 5th month with the 6th month weight loss thing and am hoping to have surgery in jan...CANT WAIT!!

[rensan65 0]

Hey Kaninag,

I made my appointment for Friday. Figure better start now.

Good luck and let me know how you did.

Rensan

[kaninag 35]

Good luck to you as well!!!!

[4jin 0]

Is it easier with BCBS or with AETNA?

Does anyone know?