Bcbs

[Teresajo 0]

I have had just as many problems with insurance companies as any one else has, but for the first time that I can remember I actually have something good to say about BCBS of california.

I was going over my claims for the whole lap band journey. I've had some complications with a stay in ICU and was expecting a huge, totally unpayable bill.

But it turns out that my total medical bills for this experience are around $93,000.00 and I owe a whopping $1300.00. Makes me almost happy to pay that weekly premium.Almost

[suecasb 0]

:help:

I need to write a letter of appeal to BCBS. I know I have seen offers of help with such a letter on this board but now I can't find them. Would someone please point me in the right direction?

[Teresajo 0]

I have freinds that have used this site. Hope it helps

Bariatrics - St. Luke's Episcopal Health System

[suecasb 0]

Thanks. I checked out this site but the sample letter they have is for your doctors office to send. I have that one but I was told that I need to write a letter too and I have no idea how to do it.

[Ellisa 6]

Sue,

Make a list of all your weight loss efforts (doctor supervised or not) explain what caused you to fail (i.e. cravings, hunger, lack of continued weight loss, etc.). Make a list of your health issues related to your weight. Make a list of problems caused by your weight. Once you get your facts down, put it in a letter form. Make sure that you include your yearly weight records for whatever period your insurance requires. Explain why you and your health care professionals believe weight loss surgery will help you succeed.

I don't know how this works for appeals, but a friend of mine wrote a letter of that nature since she was unable to provide her medical records for the 5 years her insurance requested. (Long story.) She was approved.

I'm sure others will have even better ideas.

[suecasb 0]

Thanks Ellisa, they have all that from my doctors. I'm not sure what they want so I guess I will just tell them the same things over again.

[Ellisa 6]

Sue,

Were you able to get information on why it was denied? You will want to specifically address their reason.

I was denied 4 years ago by Med Mutual. They didn't give me a reason except I didn't meet the criteria, but nothing specific. I didn't appeal at that time because there was just too much going on for me to deal with it. And I was requesting approval open RNY then and couldn't have gone through a surgery at the time. At the time, very few facilities were doing lap RNY and lap band wasn't covered by my insurance, I don't know if I'd even heard of it then. So it was disappointing, but in the end I'm glad it was denied. I lost some weight, regained it, I think a couple of times during that period. But this last time was the last straw, so I decided to see if I qualified for approval for lap-band with BCBS since the place I work had switched in the meantime. You can bet this time I would have appealed and fought all the way but I was fortunately approved without that.

I'm sure others who have had to appeal can help you out. At least this bumps it up.

[SuzanneG 1]

I had to write a letter of appeal and BCBS actually called me and said they had never seen one like mine before. It took me months, but I gathered letters of support from my GP, Gastrointerologist, podiatrist, and GYN, then wrote a medical centric letter and an emotional centric letter. BCBS loved it. I'd be happy to send them to you if you want to post your email address.

Good Luck!

Suzanne

[suecasb 0]

Thanks Suzanne, I sent you a private message.