Denied Again!!!!!

Hi all, Well I received my second denial letter yesterday. I had my self a good cry and now I'm trying to figure out what to do next. I almost said screw it and try to live this way. But I just can't give up. I am going for the next appeal level which is a face to face. My sister-in-law (who is about 40lbs overweight) says I should try to do it on my own. Is she kidding? Every single day I wake up and say that I'm going to eat healthy and small portions. But I rarely stick to it. Hunger over powers me! Any suggestions on a face to face meeting with BCN would be greatly appreciated. Thanks for letting me vent! Joni

Did they say why you were denied?

Yes, they are using the 12 month rule. I provided them with proof that I was put on a Diabetic diet and excercise program in Nov. of 2005 and I have been to the doctor everymonth since then because my sugar is not controlled. Now they say I should have tried weight loss meds and have a diary. That's the long and the short of it. J

Do you have a letter from your PCP stating how long you were under his care receiving some sort of weight loss guidance? You stated you started back in November 2005, but how long did those apppointments last? Have you done Weigh****hcer, Jenny craig, Nutri system, etc? If so get those records and send in as well. Dont give up, you just need to figure out what they want.

You can appeal to the state. That is what I did. Make sure that you send a copy of everything, including any coorespondence from you or BCN. Have your PCP write another letter stating the reasons why. My second denial was for a FAILED psych exam. I sent them EVERYTHING, plus I found out that her speciality is GERIATRIC not BARIATRIC!! I also gave them three options which I felt I could comply with. They choose the best one - overturned their decision!! Keep your chin up!! You will get it....

Ok, first of all, that is just crazy. Requiring a diary is just about the dumbest thing I have ever heard. What is to stop you from sitting down tonight and just making entries and back-dating them? I would use your doc as a resource. Maybe a letter stating why the doc didn't offer you weight loss drugs would help. Saying something about side effects and low success rates might help as well. Do your own research on WL drugs and you'll see that the side effects usually outweigh (no pun intended) the benefits. Have that arguement ready when you go to your appeal so it looks like you did consider that as an option. Good luck on your face to face. Brenda

Joni don't give up. Do the in person appeal, it makes all the difference. It took me a year and an inperson appeal to get approved. They want you to give up. When you go in person have a speech ready, you get 15 minutes to say what you want and then they ask you questions. Then you get the answer i think it is in five business days. I can send you my appeal speech i used if you need some guidance. They need to see what you're going through. Hugs Linda

Hi Linda, I would love to see a copy of your speech. See my profile for my e-mail address. I appreciate everyone's good thoughts. My husband and I decided today that we will not give up! Peace and love, Joni

Joni, I agree with Linda DO NOT GIVE UP!!!!!!! I had to go through an in person appeal as well even though my husband works for BC/BS ! I was denied for the same reason however, when I got the 2nd denial letter I discovered the doctor that review my chart was a pediatrician !!! I also have a great appeal letter and speech that I used but trust me, you can just speak from the heart and it does not hurt to bring family members who can attest to just what you are going through. I got the call the day after my in person appeal and they approved me. Let me know if you need any help I will be more than willing to help you in any way needed since it was just in June of 06 that I went through this and I am glad I did as of today I have lost 120 pounds ! 105 since 9-11-06 the day of my surgery and I feel fantastic!

I also have BCN. They are the worst ones to deal with. There are a few of us on this board with BCN and we have all had a fight with them. Mine wasn't too painful....I only had to wait about 6 weeks and I was only denied once. I can only say keep trying. Keep fighting. Your life is worth it. Stacey B