nothing ever goes right/insurance bad faith

Barb S
on 6/12/05 4:24 pm - Beecher, IL
I've been on the battlefield for 7 mo. Fighting a self fund teachers plan. The administrator of the plan, not the school (employer) decides the ambiguous bad judgement exclusion for wls will stick. Been jumping through hoops. School tried to get them to overturn it, but won't. Bmi 46 with 4 co morbids. Now I am told I can sign up in husbands plan in sept for new enrollment BCBS HMO of Il. they do cover surgery... Surely I'll have to wait 6 mo even though the criteria is met. I'm depressed, disgusted, and tired of waiting. Even the nurse of surgeon does not like me waitingthis long. I am on too many medications. Union lawyer may help. Has anyone ever had to deal with an insurnce third part rep tpa, where they never consulted once with a doctor, just decided it was too costly, and an exclusion is an exclusion, and the employer disagrees. I just want this to end, and be healthy again. Tell me what to do. Even the nurse has never seen a tpa handle a claim in such an unprofessional way. Nothing ever goes right.
Shelly LaChance
on 6/13/05 3:17 am - Chester, IL
I'm not sure about your insurance but if I was you I would do a diet with your Dr. if you don't have one I needed a year some need 6 mo with a Dr. or what ever,your day will come I'm sure it just takes so long when you start this best of luck to you.. Shelly
Nancy R.
on 6/13/05 3:18 am - Mokena, IL
Barb - I do not have any answers for you but I wanted to say stick with it, no matter what. Do not let anyone discourage you. We are all here if you need us, just holler!! Best of luck, Nancy
caneville
on 6/13/05 12:51 pm - Edwardsville, IL
Barb-- all I can say is hold in there! This can be a long process, but it will be well worth it in the long run. If you can try to find out the requirements for the insurance that your husband will be getting in Sept. See if there is anything they require that you haven't done yet. More than likely you will have to do some sort of doctor supervised diet, so jump in and get started. That way when Sept. comes to can have about 3 months done already! Before you know it you will be looking back at this and laughing! Best of luck. If you ever have any questions or just need to talk you can always e-mail me [email protected]. Good luck!
The Merchant Girl
on 6/14/05 10:40 am - Prairieville, LA
Barb, I have BCBS of IL PPO. I have to have a 12 mo supervised diet and exercise regimen. Good luck! Beth M
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