Question:
excluded what do you do iam so depressed
after you have goned through all of the testing my doctor required it was very big let down for me and i just donot know what to do .htis was my last chance — linda P. (posted on April 14, 2003)
April 14, 2003
I think you need to call the insurance, the Dr., or something and find out
the reason for denial, because Blue Cross/ Blue Shield does cover WLS.
Maybe not where you're trying to get it done at, or maybe not the type of
WLS you're trying to get, but they do cover some types of WLS. There are
also appeal letters out there you can get. Don't give up! Good luck!
— Bridget J.
April 14, 2003
Hey chica, perk up if you believe this was your last chance then you have
to fight it, I was prepared to go to war with the insurance company if they
denied me, but they didn't,I am 5 weeks post-op, what insurance do u have
as you did not mention-but like I said I would fight it and like the
previous poster said I would appeal and if they have the exclusion policy
then perhaps you can find another insurance company or find out why they
denied you, but don't give up ma, if you want it bad enough you will stop
feeling sorry for yourself and go kick some ass!!! Supporting you all the
way from Philadelphia...Tori
— TotallyTori
April 14, 2003
Hi, I am in California, and blue shield denied me 3xs, I appealled
everytime and finally after almost a year of going back and forth, I was
finally approved. You need your primary physican on your side, you need to
have recent medically supervised diet documentation. So don't give up, stay
positive and use all your resources available to you. I did, and I am so
grateful, Take care, Rose
— Rose B.
April 14, 2003
— leslie M.
April 14, 2003
Hi there. First of all, don't give up! It's NEVER your last chance! You
can always change insurance co's. Sure it's not always easy, but I've even
read profiles of people who have changed jobs so they can get a different
insurance co who approves wls. I have BCBS of Arizona, and I was denied
the first time, but approved on my appeal. You didn't say what BCBS's
reason for the denial was. Ask questions and find out why. For me, they
just wanted proof that I was doing pre-op counseling. Once I got that
proof to them (I had to do some counseling first - minor setback) they
said okay. You also did not say why you felt this was your last chance.
There is always room to appeal, several times! I mean, short of the ins co
getting a restraining order against you, appeal appeal appeal! If you need
help with an appeal, there is a book about wls by Michelle Boasten that has
a good sample appeal letter in it. I agree with previous posts regarding
getting your PCP behind you. Ask your PCP to write a letter to the
insurance re: the medical necessity of this surgery for you. Don't give
up. I know it's disheartening. I just got my approval and I had been
working on it since 12-29-02. Some are lucky and get approval in 2 days,
but most like us must jump through hoops and appeal. Ask questions and get
info --just don't take no for an answer. A positive attitude goes a long
way, even if you have to fake it! Good luck!
— beeda
April 15, 2003
Hi Linda! Don't give up! There is hope, and that is not the final
deninal. Try these routes next. When you appeal you need to have your
doctor do it...and apply direct to your plans Medical Director. Your
doctor must write an appeal request, then follow it up with a phone
inperson to your plan's Medical Director. You get this person's name and
contact information through member services at the phone # on the back of
your insurance card.
If you need more help or have additional questions. Feel free to email me.
— Lisa Pitzer
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