Some Good News ? About My Denial

[Guest guest]

In a message dated 10/14/03 6:55:46 PM Central Daylight Time,

kfwilkins@... writes:

And yes, Wolfie, if I have to dig ditches in 100 degree heat, I'm

gonna get down to what my driver's license says I weigh .

W.

Birmingham

Dr. Schmitt

,

I remember when I started this process I went back as many years as I

could remember and had EVERY DOCTOR RECORD I could think of sent to Dr.

Schmitt's office and every one had documentation of a weight problem and the co

morbidities that went along with it. Plus I got a letter of recommendation and

medical necessity from my pcp. I would have it all ready, copied and sent to

your

insurance and start it over again.

[Guest guest]

Well, I think I've got some good news about my denial. I called the

Dr.s office today and they said I was denied because of a pre-

existing condition. I quit my (sucky) job on March 28 (had BCBS),

took 5 weeks off and started my new (wonderful) job in May, but my

new insurance (also BCBS) didn't kick in until June 1. What BCBS

doesn't have on record was that I was on hubby's insurance (UHC)

during the intervening time. DH has already called his employer to

get a certificate of coverage, and hopefully we'll have that in the

next day or two.

When I was talking to the Dr.'s office, the nurse seemed to think if

I can get the continuous coverage thingy corrected then I'm good to

go. But the cynic that I am, I called BCBS just to make sure. They

said that yes, it was a pre-exiting condition, and I couldn't have

surgery until January. But they said I was also denied because my bmi

was below 40. I asked if they deny everyone under 40, or do they

recognize 35-39 with comorbidities. She said in the case of 35-39 I

would have to show medical necessity. Then she said they had nothing

on record showing medical necessity (my pcp wrote a letter, it was

supposed to be submitted with the request). Then she said there was

nothing on record showing medical necessity that didn't predate June

1.

I left it at that...so now I'm confused if it's simply a pre-existing

condition, or if I still have to show medical necessity (regardless

of when it started). I'm calling the surgeon's office again tomorrow.

I have completed all my pre-requirements for surgery as of Monday.

And yes, Wolfie, if I have to dig ditches in 100 degree heat, I'm

gonna get down to what my driver's license says I weigh .

W.

Birmingham

Dr. Schmitt