Question:
Update to a prior question I posted last month about when to call for status
— jenbn (posted on July 7, 2008)
July 7, 2008
I have BC/BS of IL and they required me to show and document all the
programs that I tried in the past years, which one of them was a number of
times WW. I had to see a doctor/nutritionist based program monthly for 6
months to meet the requirements. Weight Watchers in my insurance would not
meet that.
— usfour
July 7, 2008
I have bc/bs of alabama, I printed out the policy for wls and the way I
read it, you have to have dietcian counceling for 6mos under the
supervision of the surgeon that is doing your surgery. the Insurance lady
where I am going agrees? so much fine print! this website has taught me
sooo much. susie
— clang6
July 7, 2008
I have BC/BS and all my doctor needed was my weight for the past 5 years
and everything I tried to lose weight (ex. meds and programs). I have my
approval within 8 days. Sounds like somebody is dropping the ball.
— fifi01
July 7, 2008
I understand where you are coming from. I also was denied the first time
but mine was due to the wording on one of my evals. However, after a few
weeks it was corrected and I recieved an approval. Give the doctor's office
some time to work on it. I am sure they will help you get what ever it is
that needs to be done and you will get the approval. It is hard waiting but
it allows you the time to get the mind set that you will need to be on the
losing side.. Good Luck
— Alvernlaw
July 7, 2008
Just for your information. There are attorneys who will take your case on a
pro-bono basis. You need to look for one in your state who will handle
this. Look on the internet or contact your surgeon for advise. Many
attorneys today are doing this successfully. My friends (husband and wife)
won both cases rather quickly. Good Luck
— Ira Sansolo
July 7, 2008
Jennifer, Don't give up. I went through a similar experience. I was told
by the doctor's office that after my paperwork was submitted that they
don't want you to call them for a 3 months, because it takes at least that
period to get the insurance approval. So, I played by their rules only to
find out that the insurance didn't even have my paperwork. When I finally
got involved with it, it took me several calls between the doctor's office
and the insurance but I finally got approval, only to have the doctor I was
working with decide to stop taking my insurance and if I wanted him to do
my surgery I had a 2 week window to get fitted into his surgery schedule.
Well, after all the hassle with his office, I decided to change doctors and
it took the new doctor 3 weeks to get my approval only. So there are
difference in doctors. Just don't give up and keep pushing the insurance
and doctors office to help you. Good Luck.
— redbear
July 7, 2008
I'm afraid you have discovered how insurance companies work. They will
deny a covered benefit or delay payment of an approved benefit to float
their cash. Some insurance companies deny ALL claims over a certain amount
for 2 rounds (the first submission and then the first appeal.) You have to
get to the third appeal before you ever reach someone with any medical
training. The insurance companies are NOT on your side. They are not your
friend, buddy, or pal. They do NOT care about you or your situation. It
is ALL about the bottom line, the money. For them it is strictly business,
so you must think if it that way as well. You have PAID for this benefit
and they need to give it to you, even if you have to force them to do so.
Yes it is frustrating and stressful. That is why I got an attorney; I got
tired of the run around. Can it be done without an attorney? Absolutely!
You just have to be persistent. Send every communication certified mail.
You can win.
— MAG
July 7, 2008
Jennifer, all I can say is that I have been there and done that...LOL! I
also have BCBS...and I was first denied because they said that I didn't
have something in my files...can't remember exactly what now...but
something that had been done. I had done Weight Watchers all of 2004,
January-May of 2005, missed June, July-Oct of 2005...the lady at the
insurance office (doctor's office) told me that I couldn't use any of 2004
(this was in 2006 when I was trying to get approved), and I didn't have 6
straight months of the program in 2005 (because I missed June). I had to
sign a form stating that I was aware that I didn't have the 6 months and it
was submitted to the insurance...so I found this very frustrating, also. I
started the process in January of 2006 and finally got approval in Sept.
During that time, I had other friends and acquantances who started the
process and got approval within 3 months or less. I held in there, though,
and finally had surgery in November 2006 and have now lost 119 lbs...so
don't give up...just keep in mind that our timing isn't always God's
timing...and maybe there is a reason there needs to be a delay! I was like
you and held back some...but when I finally started making calls, more
seemed to happen...and I can also understand your frustration on the faxing
business...the insurance person at the doctor's office kept telling me my
paperwork was faxed in, BCBS kept telling me they didn't get it...they
would give me a new fax number, I would give it to her, she would fax
again...they didn't get it...finally she got a number from them that
worked...so I definitely know your frustrations...Take care and let me know
if you have any other questions...
— BrendaMS
July 8, 2008
The process can be very frustrating, but please know you have a right to an
appeal. Write a letter to explain the 6 months of diets and ask for an
"appeal". They will bump it up the chain of command and give you
a response.
— urrn4u
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