Question:
I have been denied 3 times--went to HR person Please HELP!

There is an exclusion in the policy. I have BCBS PPO I am in South Carolina. The policy is through my husbands job. I have been denied 3 times, have taken it up with the Human Resource person, even gone to the person above the HR person, and they say they can't do anything. (although everyone says that they see it is medically necessary--even the insurance people) NOW I want to write a letter to the President of the company and ask him to consider changing the exclusion...Can someone help me write a letter that will make him see that this surgery is just as important for me as a lung transplant or heart transplant is to some- one else. Sorry to be so long, but it's hard to tell you what I need in just a short sentence. IF YOU CAN HELP ME WITH A DYNAMITE LETTER I WOULD REALLY APPRECIATE IT. THANKS friends in advance!!    — cindyedens (posted on July 30, 2003)

July 31, 2003
First, try the polite route. Go ahead and write a letter to the company bigwigs. Pour your heart out, make it as personal as possible, include any research you have, etc. Make sure they understand that you are being DENIED life saving surgery. Ask they to intervene for you on your behalf - convince them it would be a great PR story. Let them know that you are also prepared to go to the media. Go to Obesity Law.com. In many states it is ILLEGAL for insurance to refuse surgery if you have docs stating it is MEDICALLY NECESSARY. Make sure you have every doc on your side: Primary Physician, Cardiologist, OB/Gyn, ENT - if you have sleep apnea, the bariatric surgeon, Psychologist, orthopeadic, podiatrist if you have to, etc. If you haven't seen some of these - go to them - get their support in a letter. Let them know you cannot rest until you get this surgery and you are going to die if you don't get it - I told my insurance company that I would spend the rest of my life, however short, nmaking sure they were hit with every lawsuit, sanction, and publicity stunt available to me even if it was the last thing I was able to do! Get your friends and family to help you picket the company and the insurance company, threaten a letter writing and e-mail campaign. Usually just the hint of bad publicity gets you some action. Will keep you in my prayers and good luck!
   — Deborah F.