Pound4Pound
Blindsided by Success
Jun 27, 2009
I am so happy today.I am so sad today.
I feel so liberated.
I feel so shocked.
I did get what I was asking for. A letter from my human resources department overturning Blue Cross and Blue Shield of Alabama in their decision to deny coverage of the Duodenal Switch. It is not the actual approval, but it is the next best thing. I was so elated for about 5 minutes. Then all the fore mentioned emotions hit me like a wave from a turbulent sea.
My Mama always told me to be very careful of what you ask for. You just might get it. I have researched this until my eyes were on the verge of falling out. I do not think there is one more thing out there for me to read on this subject. I have made my choice, and I am sticking with it. I know all these feelings are normal and expected. I just wasn't as ready for them as I thought I was. I am scared, but not for me. I am scared for my family. I am scared of them being without me. Who is going to walk my little girl (10) down the aisle on her wedding day? Will it be me? Who will teach my son (5) about sports? About women (yeah! like I've figured them out) and how to treat them? About how to be a good husband, father and man?
I know, blah blah blah..... yadda yadda yadda..... Get over yourself and pick yourself up. Let's get this over with and get things where they need to be. I have read a hundred or so of these posts. I know mine is no different. Well for those out there battling their insurance companies, do not give up. Fight the good fight and soon you could receive the following letter as well. Good luck and God Speed to all!
Some of the names below have been changed in order to protect the innocent (snicker). My last name has been omitted for security.
Dear Ms. (my appeal specialists):
This is in response to your letter dated May 23, 2009, concerning Blue Cross Blue Shield of Alabama's (BCBSAL) denial of a proposed bariatric surgery procedure for William. Your letter is considered to be an inquiry under the International Paper Company Group Health and Welfare Plan (the Plan).
According to the information available to us, Dr. Dennis C. Smith, Jr., M.D., requested preauthorization from BCBSAL for coverage of CPT 43845 - biliopancreatic diversion with duodenal switch. BCBSAL denied the proposed surgery on the basis that this is not a covered procedure under the plan.
As part of our review, our office contacted two other claims administrators who handle selffunded medical plans for International Paper. We asked these two claims administrators whether "biliopancreatic diversion with duodenal switch" is considered a covered procedure when the patient meets the claims administrator's established criteria for bariatric surgery. Both of our other claims administrators indicated that this procedure would be covered if the patient meets their bariatric surgery criteria.
As a result of this review, we have instructed BCBSAL to cover biliopancreatic diversion with duodenal switch when the patient meets BCBSAL's established criteria for approval of bariatric surgery. We have asked BCBSAL to review the medical documentation submitted by Dr. Smith to determine whether Mr. William meets their bariatric surgery criteria. BCBSAL will respond directly to Dr. Smith and Mr. William with their determination.
Sincerely,
Benefits Analyst,
Global Compensation and Benefits Office of the Plan Administrator
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About Me
Prattville, AL
Location
26.2
BMI
Surgery
11/06/2009
Surgery Date
Oct 14, 2008
Member Since
