Question:
IDoes this make sense?
BCBS-fl-ppo--changes the rules everytime you meet one qualification---now they tell me I must have proof of a dr. supervised diet for the past 12 months--and as it goes--dear old BCBS does not cover the cost of a dr. supervised diet--the won't pay --not even a copay--I don't see how this is right---my PCP wrote a letter stating I am a diabetic and have been on a diet for 15 years--and I provided a 14 month history with Metabolic Weight Loss--but they will take neither--any ideas---Walter is next on my list for help--- — Linda L. (posted on April 23, 2002)
April 23, 2002
I think there are so many of us getting the surgery that the insurance
companies are getting tougher. I had federal bc/bs and had no problems,
but when I went to talk to my primary doctor when I was first considering
it, they wouldnt pay a cent because they dont cover weight loss. Doesnt
make much sense to me. Anyway, have you been on the fen-phen diet at all
in the past? Most of us have, mention that to them--see if that helps.
Wish I could help you more. Good luck!!
— Cory F.
April 24, 2002
I have BC/BS of Fl-HMO and they denied me the first time for having too low
of a BMI. Then when I went to file again, I came to find out through my
doctors office that they required 12 months of physician supervised diets.
I have searched high and low, but can only find about 4 months of
documentation. Many places do not keep records after 5 years. I am now
jumping through the hoops that they want me to and waiting it out. I first
applied to my insurance last July. If they deny me after I have met thier
qualifications, then I will most certainly hire a lawyer and appeal from
there. You should contact legal help, if you feel they are jerking you
around. Good Luck!
— Tara J.
April 24, 2002
I have BCBS of fl PPO with the state. One thing I have learned about
insurance is that the employer unknowingly sometimes selects a plan with
restictions. For instance, I had no problem getting approved and I didn't
even have to send a letter from my PCP doctor. I sent a diet history,
family history, sleep apnea results and thyroid results. I have heard some
people on here go to their employer and have them make exception with the
insurance. I'm not sure how all that works, maybe ask for those who have
done that and get some direction. God Bless and Hang in there.
— Cheryl S.
April 24, 2002
I found these two great responses to someone elses question on exclusions.
I hope they help. CherylS
"I would suggest you hire Walter at obesitylaw.com. I have not
personally used him, but know others who have. He is well worth the
$300-400 he charges to fight these kinds of issues. My feeling is rather
than battle with the insurance company of months and months, have someone
like Walter send one legal brief outlining obesity discrimination, etc.
Within a week you will probably be approved.
- Joanie Juarez
04/23/02:
I successfully appealed on the grounds of discrimination against the obese.
My plan pays for treatment of alcohol and drug addiction which has poor
outcomes but wouldn't pay for this procedure which is proven to be a
success. I used the word discriminate often in my letter and left the
impression that I was ready to sue based on the americans with disabilities
act. It worked and they rewrote their policy to now include bypass
surgery.
- Lori D
— Cheryl S.
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