Breigh1974
08-01-2005, 12:59 AM
Hi,
I am currently undergoing an appeal process to my Insurance Company (BCN of Michigan). I had asked for approval to have the Micro-pouch procedure done because of all of my health issues. I am 30, and have Extreme Asthma, Diabetes, high BP, sleep apnea, and CHF. You would think that versus paying in excess of $2000 a month for all of my meds, that they would rather just pay for my surgery. I am NOT giving up!! I will hire a lawyer before I give up. I want to see my kids grow up & I wanna be able to go outside and play with them.
Anyone else goin through crap with insurance companies?????
I could use some positive news :-)
Breigh1974
I am currently undergoing an appeal process to my Insurance Company (BCN of Michigan). I had asked for approval to have the Micro-pouch procedure done because of all of my health issues. I am 30, and have Extreme Asthma, Diabetes, high BP, sleep apnea, and CHF. You would think that versus paying in excess of $2000 a month for all of my meds, that they would rather just pay for my surgery. I am NOT giving up!! I will hire a lawyer before I give up. I want to see my kids grow up & I wanna be able to go outside and play with them.
Anyone else goin through crap with insurance companies?????
I could use some positive news :-)
Breigh1974
Sponsor
thinatheart
08-07-2005, 01:13 AM
I too would fight them to get approved, even if it means hiring an attorney. I am still waiting on final approval. I want this so bad. I have young children too, so I am desperate to be able to keep up with them. I have asthma, sleep apnea, hbp, depression, high cholesterol, etc. I have been approved by my carrier (BC/BS TN) but I have to approved by BC/BS AL too, so I am crossing my fingers and toes, and praying for approval. I should know something in a week or so. Good Luck and Keep Trying.
Valerie_s
08-07-2005, 02:29 PM
I too live in Michigan and I worked for the hospital in Detroit that does these surgery's, what I have learned about the insurance companies and the surgery is that if your physician feels you have not put abmple effort in trying to lose weight on your own , the insurance company will not approve your claim, indefinaltey it sounds to me as though you have definate medical issues but that in itself is not enough when being approved for this sugery, my doctor and I have had this conversation a million times and he refusees to do it also
Falynsmommy
08-09-2005, 10:17 PM
My mom, who is known on this board as BigGal1958 just found out today that she was turned down by Blue Cross Blue Shield because she did not have 12 consecutive months of being under a doctor's care strictly for weight loss. It didn't matter to the insurance company that she had over 2 years worth of Weight Watchers documents, or that she had over 2 years of doctor's files where he wrote in obesity, that she was on Weight Watchers, that she was on Atkins, etc. The insurance company told her that she would have had to go to the doctor every month and have documented proof that she was in his care strictly for the weight loss. It didn't matter that it was all weight related issues. Such as high blood pressure, sleep apnea symptoms, depression, etc.
The big problem is this. BCBS stops covering this on September 1st. She doesn't have time to appeal this and she doesn't have time to get 12 months of doctor documented weight loss attempts. She is going nuts. She had her heart set on this surgery. She was going to have the Lapband procedure. She feels like she is at the end of her rope. She is 47, way too young to be giving up on life. I am her only child and she has two young granddaughters. I would lose it if I lost her. She feels like she has tried everything.
I will do whatever I have to to help her lose this weight. She has gotten to the point that she can hardly walk from her car to the house because of the legs swelling. Does anyone have ANY ideas whatsoever? Any advice, kind words, ideas, anything would be helpful. Thanks and good luck to all of you.
The big problem is this. BCBS stops covering this on September 1st. She doesn't have time to appeal this and she doesn't have time to get 12 months of doctor documented weight loss attempts. She is going nuts. She had her heart set on this surgery. She was going to have the Lapband procedure. She feels like she is at the end of her rope. She is 47, way too young to be giving up on life. I am her only child and she has two young granddaughters. I would lose it if I lost her. She feels like she has tried everything.
I will do whatever I have to to help her lose this weight. She has gotten to the point that she can hardly walk from her car to the house because of the legs swelling. Does anyone have ANY ideas whatsoever? Any advice, kind words, ideas, anything would be helpful. Thanks and good luck to all of you.
thinatheart
08-10-2005, 01:36 AM
I finally got approval from bc/bs to have this surgery :bouncing: . My letter says that the approval is good until the end of my benefit year (in my case 12-31-05). My bc/bs plan did not specify a length of time you had to be on a physician supervised diet, so I only had to do it for a couple of months. Maybe you need to get a copy of her ins and look it over for these details. I am so sorry your Mom is going thru so much trouble. But, they are making this VERY difficult to get approved for. I am 45, but I have children 6, 8, 13, & 24. I know what you mean about wanting her to be around-I want to be around too. Keep Trying! Do not give up. Best Wishes! :angel:
newtim
01-14-2006, 01:26 AM
Are you Morbidly Obese to have all those medical problems ??? Why are you on appeal w/ your Insurance Co...what was there excuse that they are "NOT" paying for this procedure ??? Did you get a Doctor to write that this was Medical necessary for you...good luck let me know if they did pay or not..
giddyup715
01-14-2006, 10:55 PM
This insurance stuff just baffles my mind! At our place of enployment we are offered 3 types of health insurance. First is Priority Health which does NOT cover GB surg. Then, there is BCBS which does. I work with 2 women that are at least 150#-250#'s overweight. I'm from Mich. also.
Woman #1- 250#'s overweight Priority Health patient. Been trying to get GB surgery for 1 and 1/2 years. Going thru the hoops, high blood pressure, sleep apnea testing, pysch. counseling, weight loss counseling (has to meet 10 criteria's for the surgery) Short 5' 3" heavy woman, 50 ish and breathes so heavy walking that I'm afraid she is about to pass out walking to her work station.
(Note:was required to go to Mayo Clinic for testing for a weekend $$$$) !!!
Woman #2- 150#'s overweight, 42 years old, tall about 6 ft. No high blood pressure, but has to take Prilosec for heartburn, knees are sore from weight but walking is fine, and breathing too. She was on Priority Health then switched over to BCBS because they would pay for the surgery. She is
now scheduled for GB surgery 2 months after switching over. She went for the testing and met 3 of the requirements. She will be getting her surgery March 3 after only two months of testing.
Now, for the life of me, I cannot understand why woman #2, everytime she wants the simple way out (surgery for whatever reason) gets it and time off work paid. And then she milks it out NOT to come back to work till the last minute.
Now, you may think it's the Dr. :nono: Not necessarily so. Woman #2 and I both go to the same Dr.
Insurance is fighting me all the way on a procedure that I need which only cost $500 (due to a tumor). They consider it cosmetic. I consider it afraid to go out in public because of this.
I appealed and am in my second appeal.
What I want to know is this, how come some women can fly thru the system and get what they want and need while others have to fight tooth and nail to get it. BTW, woman #1 needs this surgery so much more than the other and I'm worried about her health. Woman #2 could lose the weight easily but she hasn't even tried to be successful. She just says, let the surgeon do it for me. Easy way out.
And please don't give me grief about woman #2, she hasn't even tried to lose any weight like woman #1. I'm afraid the woman #2 is going to be in for a serious wakeup call when she can only tolerate a thimble-full of protein drink compared to 16 ozs. of pasta on her plate.
Myself yes, I am overweight and would be considered for bypass, but I'd rather lose it on my own because I know I am capable of it and really don't care for the after-affects I've heard so much about.
So, I just don't know what to think. :confused: :eek:
Woman #1- 250#'s overweight Priority Health patient. Been trying to get GB surgery for 1 and 1/2 years. Going thru the hoops, high blood pressure, sleep apnea testing, pysch. counseling, weight loss counseling (has to meet 10 criteria's for the surgery) Short 5' 3" heavy woman, 50 ish and breathes so heavy walking that I'm afraid she is about to pass out walking to her work station.
(Note:was required to go to Mayo Clinic for testing for a weekend $$$$) !!!
Woman #2- 150#'s overweight, 42 years old, tall about 6 ft. No high blood pressure, but has to take Prilosec for heartburn, knees are sore from weight but walking is fine, and breathing too. She was on Priority Health then switched over to BCBS because they would pay for the surgery. She is
now scheduled for GB surgery 2 months after switching over. She went for the testing and met 3 of the requirements. She will be getting her surgery March 3 after only two months of testing.
Now, for the life of me, I cannot understand why woman #2, everytime she wants the simple way out (surgery for whatever reason) gets it and time off work paid. And then she milks it out NOT to come back to work till the last minute.
Now, you may think it's the Dr. :nono: Not necessarily so. Woman #2 and I both go to the same Dr.
Insurance is fighting me all the way on a procedure that I need which only cost $500 (due to a tumor). They consider it cosmetic. I consider it afraid to go out in public because of this.
I appealed and am in my second appeal.
What I want to know is this, how come some women can fly thru the system and get what they want and need while others have to fight tooth and nail to get it. BTW, woman #1 needs this surgery so much more than the other and I'm worried about her health. Woman #2 could lose the weight easily but she hasn't even tried to be successful. She just says, let the surgeon do it for me. Easy way out.
And please don't give me grief about woman #2, she hasn't even tried to lose any weight like woman #1. I'm afraid the woman #2 is going to be in for a serious wakeup call when she can only tolerate a thimble-full of protein drink compared to 16 ozs. of pasta on her plate.
Myself yes, I am overweight and would be considered for bypass, but I'd rather lose it on my own because I know I am capable of it and really don't care for the after-affects I've heard so much about.
So, I just don't know what to think. :confused: :eek:
thinatheart
01-15-2006, 02:09 PM
I waited 3 yrs before having surgery, because our ins wouldn't cover it. As soon as I switched to BCBS TN, I was on my way. I had to jump thru several hoops to get it: diet history, meet with psych dr, meet with dietician, be referred to surgeon by another dr, and had several health problems: sleep apnea, asthma, depression, high bp & cholesterol/trig, acid reflux, & arthritis. I was about a 100 #s overweight. I had surgery Aug 17, 2004 (260 lbs) and now weigh 185ish and am 5'6. I am very happy with my results and I did try other means before having my surgery to lose weight, it is not the easy way out by no means! I have attended a GBS Suport Group for 3 yrs prior to surgery & still attend regularly (they meet once a month). Best Wishes!