Guest guest Posted January 21, 2005 Report Share Posted January 21, 2005 I think there is something wrong with this statement. I moved from New England to New Mexico. In New England, I had insurance that is an individual policy that I purchased after my implant. When I moved, I again purchased an individual policy which is a Medicare Plus policy but I did some shopping before I purchased the one I decided on and even was approved by Blue Cross as an individual policy. I am not on a Group policy. Mine is individual. Now - I did have a problem with auto insurance once. I've never had as much as a ticket never mind a moving violation but Geiko refused me because of my hearing loss but I am just moved on and insured thru All State. Alice < was told that NO private insurance would cover a person with a CI. Group insurace has to, but no individual policy would cover a person with a CI. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 11, 2007 Report Share Posted June 11, 2007 Hello, I had my MGB in September of 2003 and am doing fine. My insurance company did not pay and I knew going into it. What I need help with is has anyone been able to get BCBS to pay? My brother-in-law had the MGG surgery in February and was very much overweight and needed the surgery. He is doing fine, but financially like the rest of us he would like to get BCBS to pay. In his insurance it does not state they will not pay and for some reason they think he was not obese and needed the surgery. He weighed 467 lbs, which to me and him was very much obese. If anyone has anything they could share with me to help get the insurance company to pay for at least a portion of it that would be great. Any sample letters used for insurance denials as follow-ups, etc would be greatly appreciated. Also, if anyone has had BCBS pay, please let me know. I thank you in advance for any help in this matter. If I can ever be of help in anyone, please let me know. Send any info to me at dmg0110@.... Thanks and have a great day, Diane Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2007 Report Share Posted June 12, 2007 My local (Washington DC) BCBS didn't say no, but they said that since the procedure was done out of the area, I had to file with the local (Nevada) BCBS. As a " courtesy, " they filed for me. No word yet. My fingers are crossed (and my toes, legs-- for the first time in 15 years-- and anything else I can cross for good luck), and I " m getting ready to call to find out the status. :-) Kathy in VA 7/6/06 297/178 -------------- Original message -------------- From: " diane_glastetter " <diane_glastetter@...> Hello, I had my MGB in September of 2003 and am doing fine. My insurance company did not pay and I knew going into it. What I need help with is has anyone been able to get BCBS to pay? My brother-in-law had the MGG surgery in February and was very much overweight and needed the surgery. He is doing fine, but financially like the rest of us he would like to get BCBS to pay. In his insurance it does not state they will not pay and for some reason they think he was not obese and needed the surgery. He weighed 467 lbs, which to me and him was very much obese. If anyone has anything they could share with me to help get the insurance company to pay for at least a portion of it that would be great. Any sample letters used for insurance denials as follow-ups, etc would be greatly appreciated. Also, if anyone has had BCBS pay, please let me know. I thank you in advance for any help in this matter. If I can ever be of help in anyone, please let me know. Send any info to me at dmg0110@.... Thanks and have a great day, Diane Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2007 Report Share Posted June 12, 2007 First, check the policy and see if it has and EXCLUSION for weight loss. If it does, I wish you well. It can still be fought, but the chances of winning are slim. IF it doesn't have an exclusion then begin with the doctors letter of need, stating all of the co-morbities. Use his bmi, and the insurance companies guide lines for weight -height ratio. such as 5'8 " should weigh about 150 or so...for female. if you exceed that by 100 lbs or more then you are morbidly obese. Secondly, get the state insurance commisson involved. they can provide you with attorneys names that do just this sort of thing for a fee. Most charge about 750-1500 flatly. It may be worth it if they think that you can win. finally, keep track of all converstations that you have with your insurance companies. Make them put any and all of it in writing. Get the denial on paper as to why they won't pay for the surgery. Unless you brother is about 10'6 " he is grossly morbidly obese! DON " T TAKE NO FOR AN ANSWER. you paid for a policy to cover your health needs. Make sure that they know that you paid this in good faith that your health care needs would be covered. Their refusal to cover the cause of your co-morbites should be criminal, but it is not. IF you get a chance to see " sicko " a new movie by about our health care system, see it. I saw parts of it and while I think he is a bit out there with most of his views and ideas, he is on target with this issue. It is criminal that our convicted fellons get free health care and we, who pay premuims that we cannot really afford, have no guarantee of coverage: especially for the one disease that affects 65% of the population. How sad! finally, what state are you in? There are 5 states that have some guaranteed coverage for weight loss for most of their insured. Virginia, Michigan, georgia, land and Indiana. Georgia isn't just gastric bypass, it is any surgery medically necessary. Conn. covers bariartic surgery thru oxford and bcbs, mass. all insurance companies are covering it, Vermont, bcbs, mvp and cigna cover it, if riders are purchased. Maine has a guaranteed renewal policy so it isn't " not ocvered " . Rhode Island, still covering. New hamp. no coverage from cigna and bcbs. The American society of bariatric surgery did a study in Canada (which covers it) and founf that the costs of bar. bypass is recovered in 3.5 years. Send me your email addy and I will send you where I got this info. I have volumes of it and this is about the best argument for gastric bypass and it is short and quick. good luck. I suggest you put on your boxing gloves and aim for the crotch. they set the rules and the new rules are, " PLAY DIRTY " It goes for both sides. take care denise in mo ---- Original Message ----- From: diane_glastetter Sent: Monday, June 11, 2007 12:53 PM Subject: Insurance denials Hello, I had my MGB in September of 2003 and am doing fine. My insurance company did not pay and I knew going into it. What I need help with is has anyone been able to get BCBS to pay? My brother-in-law had the MGG surgery in February and was very much overweight and needed the surgery. He is doing fine, but financially like the rest of us he would like to get BCBS to pay. In his insurance it does not state they will not pay and for some reason they think he was not obese and needed the surgery. He weighed 467 lbs, which to me and him was very much obese. If anyone has anything they could share with me to help get the insurance company to pay for at least a portion of it that would be great. Any sample letters used for insurance denials as follow-ups, etc would be greatly appreciated. Also, if anyone has had BCBS pay, please let me know. I thank you in advance for any help in this matter. If I can ever be of help in anyone, please let me know. Send any info to me at dmg0110@.... Thanks and have a great day, Diane Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2007 Report Share Posted June 13, 2007 Could you send the information to me please.I worked with my insurance company for 3 onths. Jumped through loads of hoops for them. Did everything they ask. Theygave me approval and said all was go. Just send the bills to them afterwards. Well they still haven't paid and it is almost 2 years. At the time my hubby and I were paying 1000 dollars a months for insurance. I sent them the CLos letter guess I need to get the longer one and send. Each time I call it is the smae thing. We are working on it. Are we need this information are that information. I tell them to look it is in front of them and I have the conformation number of it being faxed and to who received it. So good luck.Get something in writing before you beleive a thing they say.... Wanda Jordan Dr. P / Spring branch Houston 8/2/05 295/ 149 now 5'2 " tall age 55 7 foot bypass Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.