Very discouraged~~~HELP

I have been trying to get approval for surgery for approximately 4 years now.  For various reasons, (insurance would not cover it, lost my job, got divorced, new job switched insurance companies) I have not been able to make any head way.  This past March, I made up my mind that I was going to fight for this no matter what it takes.  I am tired of being fat, not being at to keep up with my now 14 year old son, and taking too many pills very day for high bp, arthritis in my knees etc.  So in March I attended to the orientation seminar that is offered by the surgeons office.  They explained the process of getting the insurance company to approve the surgery.  (I have Anthem BC/BS Healthkeepers)  I sent my first letter on April 13 and waited and waited and waited for a response.  Finally after waiting for an eternity and being in encouraged to call the insurance company, I muster up the courage call, all the while dreading it because I didn't want to hear no we wil not cover it.   I spoke to a very nice gentleman and he looked into why I had not received a response.  He find my letter which he stated that it was received in the office on April 30 and there had been no action taken, it was just sitting there in a pile.  That was discouraging enough making me think that my health was not important to the health insurace company I pay every month.  I was told I would receive a response from them within 2 weeks.  Well 3 weeks later, here I am, received my response yesterday.  Of course it was a denial, so now discouraged with the repsonse, here I am.  Not sure which way to turn for an appeal and feel like almost throwing in the towel and daying forget about it. If there is anyone who can guide me in the right direction that would be greatly appreciated!    I'm sorry that this has been so long.  And thank you in advance for reading my post.    

First of all don't give up.  Keep fighting for your health.  Find out why you were denied and appeal it.  Check out the insurance forum here on the board and maybe someone there can give you more help.  You are worth the fight, don't give up.

Check with the WL surgeon's office (and your PCP perhaps) to see if they also will intervene or advise you on what your medical profile needs to include to prove medical necessity. Have heart - you need to continue fighting because it's darned well worth it!

Hi Hoover, I echo Courtney & Cleo's response to you...don't give up.  I pursued my surgery for 14 months & finally had my surgery on July 16th. Do you have a surgeon that has said he will perform your surgery?  From what you wrote up above it would seem you only attended a seminar.  There are a number of tests that need to be done first & maybe that's what's missing from your appeal to BCBS.  They are not going to just take your word for it, hon.  You have to show proof of medical necessity & comorbidities.  Letters of recommendation from all your doctors, to include the surgeon are also needed.  The only reason I got approved was because of the timeline I provided BCBS. I hope this helps you some in your quest.  It's waaaay too early for you to give up, hon.  This is the fight for your life!!!

You need a letter from your Preferred Certified Physicain (PCP) and your WLS surgeon of choice (that is also listed as a participating physican with your insurance).  I assume you had to have a referral to see the WLS to start with? A letter from one or preferably both of them with make a huge difference.  Even if you have to write the letter yourself and get them to put it on there letter head and sign it and submitted it to insurance fom their office. (as I did with my PCP, my suregoen did his own and it made a huge difference.) The letter(s) need to state you have whatever co-morbid-obesity related health issues (BP, apnea, diabetes (of any type/level), joint problems, etc.  As long as you do not have issues that would make surgery too risky, WLS should be a solution that would help you to be healthier and cost the insurance less in the long term and that will make a difference.   If this is your first denial form this insurance, that is also pretty standard to have to at least make one appeal. Keep taking charge and following up or it will never happen.  You are in the driver seat, it is your health, don't be quite so patient,...don't be rude but keep thing moving and don't be afraid to hold people to deadlines.  Ask when can I expect that to be done,..how long before I should call back or hear something and do it, and keep doing it until you get a date,...with out being rude.  You can be tenacious and consistent without being rude or angry.   Frustration is a natural phase of this process.  It is more difficult than recovery from the surgery in my opinion. Best of luck and go get'em tiger!!

Hi Joe--nice to see you. You look wonderful

Aw shucks ma'am,...  ...thank you.  Is that me blushing???