Bummed out! I've been denied!

[Guest guest]

BCBS told me yesterday that I was denied. I'll find out why in a few

days when my Dr. gets the letter. They wouldn't tell me over the

phone. I can't say I'm surprised, my BMI is 37.9, but my pcp and Dr.

Schmitt thought I had enough comorbidities (high blood pressure, high

cholesterol, fibromyalgia, and cerebral palsy, and very painful

joints).

I'll write more as I find out more. This will be a loonnngggg

weekend, that's for sure!

W.

Birmingham

Dr. Schmitt

[Guest guest]

Please dont give up. I was denied the last yr and I also have BC/BS

(ppo)of AL and my bmi was 39.6. I recently found a new pcp and a new

surgeon and once again have filed once more. my bmi is now 41 and I

have comorbs. to follow along. I am still playing the waiting game

but my drs. asure me that I will have no problems of being approved.

So have faith and try again. You will see good things are sure to

come your way....lord knows Ive waited almost 18months.

Good luck.....I know with all the support on here you will

survive.....

220/pre-op/120

[Guest guest]

bummer, katie. time to re-group & work on your appeal. check out

asbs.org & the NIH consensus, they both give the wls guidelines & if

your BMI is 35 w/ co-morbs, YOU QUALIFY. hang in there, hun. we're

here every step of the way.

lori h.

> BCBS told me yesterday that I was denied. I'll find out why in a

few

> days when my Dr. gets the letter. They wouldn't tell me over the

> phone. I can't say I'm surprised, my BMI is 37.9, but my pcp and

Dr.

> Schmitt thought I had enough comorbidities (high blood pressure,

high

> cholesterol, fibromyalgia, and cerebral palsy, and very painful

> joints).

>

> I'll write more as I find out more. This will be a loonnngggg

> weekend, that's for sure!

>

> W.

> Birmingham

> Dr. Schmitt

[Guest guest]

Thanks . Fortunately my pcp is wls friendly, and regardless of

that, I plan to grow old with her...she's that good. Unfortnately (or

fortunately for her) she's on maternity leave for the next couple of

months, so I'll be on my own if I appeal.

Good luck on your approval! I hope the second time is the charm.

W.

> Please dont give up. I was denied the last yr and I also have BC/BS

> (ppo)of AL and my bmi was 39.6. I recently found a new pcp and a

new

> surgeon and once again have filed once more. my bmi is now 41 and I

> have comorbs. to follow along. I am still playing the waiting game

> but my drs. asure me that I will have no problems of being approved.

>

> So have faith and try again. You will see good things are sure to

> come your way....lord knows Ive waited almost 18months.

> Good luck.....I know with all the support on here you will

> survive.....

>

>

> 220/pre-op/120

[Guest guest]

Thanks Lori! I hope I do qualify based on my comorbids. But reading

my policy today, and it says medically necessary doesn''t simply

mean " convenient or comfortable " for me. In my application letter I

stated I'm going to have to give up my job soon because of pain, and

it's a matter of time before I'm completely disabled and unable to

contribute anything to my household or anything else. I guess that

may have been simply a matter of convenience for them.

So I guess I need to convince them that I'm going to die if I don't

get this done. I have a hard time thinking about it in those terms,

much less writing a bunch of strangers about it.

Thanks again!

W.

> > BCBS told me yesterday that I was denied. I'll find out why in a

> few

> > days when my Dr. gets the letter. They wouldn't tell me over the

> > phone. I can't say I'm surprised, my BMI is 37.9, but my pcp and

> Dr.

> > Schmitt thought I had enough comorbidities (high blood pressure,

> high

> > cholesterol, fibromyalgia, and cerebral palsy, and very painful

> > joints).

> >

> > I'll write more as I find out more. This will be a loonnngggg

> > weekend, that's for sure!

> >

> > W.

> > Birmingham

> > Dr. Schmitt

[Guest guest]

hi katie,

what i know about BCBS is it varies by state and also if its a HMO or PPO

i have BCBS PPO of Illinois but live in Louisiana - to have the insurance

here its a total exclusion - when the dr first sent in all my results from

the things they ordered (labs, sleep study etc) they came back with a denial

but the nurse said it doesn't sound like an outright denial but they want

more information - i got ver depressed and slept the whole next day but i

prayed about it and said if its meant for me to have it done then i will

take the appropriate steps and if not then i will be OK with that -- the

next morning i woke with more energy than i've had in a long time and had

the thought in my head to call the dr office and have them send me what they

sent the ins co b/c i just couldn't imagine somebody reading my info and

saying i don't meet criteria - when i got the pkg that was given to the

insurance i was astounded - it was so vague and put togeather poorly -- so i

went to work - the only test i had not had done was the sleep study b/c i've

had one previously so they said it wasn't required but i didn't want that to

hold me back so first i wrote a personal letter - introduced myself and

explained how my weight was now affecting my quality of life and talked

candidly about hygiene issues and bad knees with knee replacement in the

future and getting close to needing a wheelchair and things i can't do with

my 2 daughters - i was very nice and only stated facts - i also put each

disease process with its matching ICD-9 code and the medication i take for

that problem -- i used a large easy to read letter (font) and double spaced

between listings - i also added a printout from walgreens on the cost of my

drugs for a year (it was a big stack) and finally i put a copy of my latest

8x10 family photo -- in 3 days i got my approval - the denial was overturned

a picture says a 1000 words - isn't that how it goes......also i waited to

get the paper stating the denial b/c where i had been calling said the

appeals dept isn't even in the same city - i kept wanting to call and they

said no way -- when i got that letter i bypassed the main office and sent it

straight back to where that letter came from -- i wouldn't call myself a

very religious person but the man above put that info in my head - i bet my

life on it. and do you know about a week later they sent my pic back -- i

plan to send them a thank you card and tell them to please don't look at

that as pieces of paper - that is a person in there - i was a pkg of 52

papers.

visit our website

www.geocities.com/tanyarn96/countryside.html

www.poncetihomes.com

-- Re: Bummed out! I've been denied!

In a message dated 10/11/2003 4:16:53 PM Central Standard Time,

kfwilkins@... writes:

BCBS told me yesterday that I was denied. I'll find out why in a few

days when my Dr. gets the letter. They wouldn't tell me over the

phone. I can't say I'm surprised, my BMI is 37.9, but my pcp and Dr.

Schmitt thought I had enough comorbidities (high blood pressure, high

cholesterol, fibromyalgia, and cerebral palsy, and very painful

joints).

I'll write more as I find out more. This will be a loonnngggg

weekend, that's for sure!

W.

Birmingham

Dr. Schmitt

,

Don't get discouraged alot of people in these groups deal with this

denial process all the time and they appeal and win. They can help you to

structure everything like it needs to be for your appeal process. Hang tough

girl!

Wolfie

Leeds, Alabama

Lap RNY

August 27,2003

Dr. Lee A. Schmitt, M.D.

Medical Center East

Beginning Weight: 336

" Keep Em Laughing! "

[Guest guest]

strangely enough, most of my letter was spent on citing medical

sources to support wls, the JAMA, Journal of Int'l Obesity, etc.

i also mentioned my family history, but i downplayed the emotional

side b/c i wanted to convince based on logic & science. i didn't

expect empathy from some (potentially) clinically dispassionate

reviewers.

you can do it!!

lori h.

> > > BCBS told me yesterday that I was denied. I'll find out why in

a

> > few

> > > days when my Dr. gets the letter. They wouldn't tell me over

the

> > > phone. I can't say I'm surprised, my BMI is 37.9, but my pcp

and

> > Dr.

> > > Schmitt thought I had enough comorbidities (high blood

pressure,

> > high

> > > cholesterol, fibromyalgia, and cerebral palsy, and very

painful

> > > joints).

> > >

> > > I'll write more as I find out more. This will be a loonnngggg

> > > weekend, that's for sure!

> > >

> > > W.

> > > Birmingham

> > > Dr. Schmitt

[Guest guest]

duh, that the INT'L journal of obesity.

lori h.

> > > > BCBS told me yesterday that I was denied. I'll find out why

in

> a

> > > few

> > > > days when my Dr. gets the letter. They wouldn't tell me over

> the

> > > > phone. I can't say I'm surprised, my BMI is 37.9, but my pcp

> and

> > > Dr.

> > > > Schmitt thought I had enough comorbidities (high blood

> pressure,

> > > high

> > > > cholesterol, fibromyalgia, and cerebral palsy, and very

> painful

> > > > joints).

> > > >

> > > > I'll write more as I find out more. This will be a

loonnngggg

> > > > weekend, that's for sure!

> > > >

> > > > W.

> > > > Birmingham

> > > > Dr. Schmitt

[Guest guest]

Thank you so much for the words of wisdom. Once I find out why, I

hope I can take appropriate action. Plus I feel I'm up against a time

crunch...I've saved up vacation to have this done, but if I don't

take it by the end of this year I'll lose it.

Thanks again for your good thoughts.

W.

> hi katie,

> what i know about BCBS is it varies by state and also if its a HMO

or PPO

> i have BCBS PPO of Illinois but live in Louisiana - to have the

insurance

> here its a total exclusion - when the dr first sent in all my

results from

> the things they ordered (labs, sleep study etc) they came back with

a denial

> but the nurse said it doesn't sound like an outright denial but

they want

> more information - i got ver depressed and slept the whole next day

but i

> prayed about it and said if its meant for me to have it done then i

will

> take the appropriate steps and if not then i will be OK with that --

the

> next morning i woke with more energy than i've had in a long time

and had

> the thought in my head to call the dr office and have them send me

what they

> sent the ins co b/c i just couldn't imagine somebody reading my

info and

> saying i don't meet criteria - when i got the pkg that was given to

the

> insurance i was astounded - it was so vague and put togeather

poorly -- so i

> went to work - the only test i had not had done was the sleep study

b/c i've

> had one previously so they said it wasn't required but i didn't

want that to

> hold me back so first i wrote a personal letter - introduced myself

and

> explained how my weight was now affecting my quality of life and

talked

> candidly about hygiene issues and bad knees with knee replacement

in the

> future and getting close to needing a wheelchair and things i can't

do with

> my 2 daughters - i was very nice and only stated facts - i also put

each

> disease process with its matching ICD-9 code and the medication i

take for

> that problem -- i used a large easy to read letter (font) and

double spaced

> between listings - i also added a printout from walgreens on the

cost of my

> drugs for a year (it was a big stack) and finally i put a copy of

my latest

> 8x10 family photo -- in 3 days i got my approval - the denial was

overturned

> a picture says a 1000 words - isn't that how it goes......also i

waited to

> get the paper stating the denial b/c where i had been calling said

the

> appeals dept isn't even in the same city - i kept wanting to call

and they

> said no way -- when i got that letter i bypassed the main office

and sent it

> straight back to where that letter came from -- i wouldn't call

myself a

> very religious person but the man above put that info in my head -

i bet my

> life on it. and do you know about a week later they sent my pic

back -- i

> plan to send them a thank you card and tell them to please don't

look at

> that as pieces of paper - that is a person in there - i was a pkg

of 52

> papers.

>

>

> visit our website

> www.geocities.com/tanyarn96/countryside.html

>

www.poncetihomes.com

>

> -- Re: Bummed out! I've been denied!

>

> In a message dated 10/11/2003 4:16:53 PM Central Standard Time,

> kfwilkins@h... writes:

> BCBS told me yesterday that I was denied. I'll find out why in a

few

> days when my Dr. gets the letter. They wouldn't tell me over the

> phone. I can't say I'm surprised, my BMI is 37.9, but my pcp and

Dr.

> Schmitt thought I had enough comorbidities (high blood pressure,

high

> cholesterol, fibromyalgia, and cerebral palsy, and very painful

> joints).

>

> I'll write more as I find out more. This will be a loonnngggg

> weekend, that's for sure!

>

> W.

> Birmingham

> Dr. Schmitt

>

> ,

> Don't get discouraged alot of people in these groups deal with

this

> denial process all the time and they appeal and win. They can help

you to

> structure everything like it needs to be for your appeal process.

Hang tough

> girl!

>

> Wolfie

> Leeds, Alabama

> Lap RNY

> August 27,2003

> Dr. Lee A. Schmitt, M.D.

> Medical Center East

> Beginning Weight: 336

> " Keep Em Laughing! "

>

>

>

[Guest guest]

I am also up against a time line....we are on the verge of losing

our ins. due to co. cut backs it can be as early as the first of the

yr. So I am hoping to have this done before then.

I looked at my denial papers from last yr to see what all it said.

Look at yours when you get them...the surgeon didnt file everything

that was needed. Plus it said that I needed more documentation that

He didnt make me to a psych eval or any blood work before he filed.

The surgeon now has made me do all these things and is sending it in

with my eval from him plus I wrote a personal letter to the ins co.

I also done a diet journal and a diet logs(all the deits i have

tried) plus got as many referrals as I could. So look at your papers

and go from there.... I gave up hope for awhile then I met a

wonderful PCP and he is my life saver.....

Pleas dont give up hope...keep your head raised high and think I

will get this done.....

of AL

220/pre-op/120

btw...you can personally email me anytime if you would like to talk

or messange me....