appeal to insurance company for surgery - Obesity Message Board

Breigh1974 · 07-31-2005, 09:59 PM

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

thinatheart · 08-06-2005, 10:13 PM

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, 11:29 AM

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, 07:17 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.

thinatheart · 08-09-2005, 10:36 PM

I finally got approval from bc/bs to have this surgery

. 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!