WTF Blue choice!

[warrior68 16]

I got a letter from BC today, not a Approval, not a denial, just a screw you we think we'll take our time and break your balls about this surgery kind of letter. The are requesting additional information because I have Crohn's disease. I called them and they I am told that they want to make sure my Dr and Surgeon know I have Crohns, and still think Lap band would be a good choice. I Explained to the lady on the phone, Of course my primary physician knows I have crohns, and you have a letter he wrote saying He supported my choice to have lap band surgery. Well sir we it needs to be reviewed by our med director now. Ok mam, could I Please speak to your medical director? Um no sir you can not, they do not talk to people. Excuse me, are you saying that your medical directors who's salary the policy holders pay, will not talk to the policy holders? Yes sir, they do not talk to policy holders. Bc has left me no choice but to be a constant pain in there buts every minute of every day until they approve me, every time thought out the day that I get an extra 2 minutes I'm going to call, and ask to speak the medical director. Damn Im figgin Pissed!!

[Marine mom 3]

I hope things come through for you.Frankly, my journey with the insurance company took 9 months so anything less is pretty good in my book.

[JudyDF 0]

My sympathies are with you. I am insurance auth nurse at my job.(getting auths for our patients) and believe me the insurance companies will do all they can do give a denial. Even after we get the auth after they review the clinical they can change their minds and say we are not paying. In the last year I have seen so many more denials it is scary. Our insurance even denies auths for our own employees and I never saw that before. My daughter went through 6 months of testing and counseling only to be denied because her company had a no weight loss surgery clause and she did not know. And when she started the pre auth process with Horizon they told her sure you can have the surgery just do all these tests and then wham they denied her. She just came back yesterday from Mexico where it cost about $6800 for everything. I was not happy with her going there but the insurance company gave us no choice. Good luck it can be a long process.

[warrior68 16]

Ok, now that I have calmed down a little bit, this still sucks. I just cant believe that they are so insane as to believe that my own primary doctor of over 18 years wouldn't know I had crohns at the time he wrote the support letter. I work in the insurance industry as a adjuster, and I always try to look at things logically, however I also understand that with insurance everyone has to always cover their ass 100% of time. I guess I'm just frustrated that they would let me get this far in to the process before saying "hey we need your doctor to say this". At this point time is so important to me, right now is my slow season if it gets past September I'll have to put it off till next spring and go through all the BS again. I'm gonna make some phone calls tomorrow and see what I can do to speed up the process, maybe have my gastrointerologist fax BC a letter, since he is the one that deals with my crohns issues. Hmmm ahh well, hurry up and wait! LOL

[Marine mom 3]

It stinks to have a time schedule like that. I hope they see some sense.

[khunt719 2]

I feel you. It took me a year of fighting the insurance and then another 6 months before I got an approval letter. I was denied right away because they didn't have enough information, I had to do all the journaling, being weighed every month, writing down all my feelings, exercise pattern...everything that went on in my day for 6 months. Finally after finishing it, I had to write an appeal letter and got approved within a month but it took 1 1/2 years to get approved. Insurance just yanks your chain and leaves you hanging. Good luck with it.

[Marine mom 3]

Just wondering if things worked out.

[karmaandkismet 0]

i am still in the pre-approval process. I do my last weigh in next week before they send off my packet for approval. One thing I've done along the way is make a copy for myself of every piece of documentation I've had to get for this lovely paper chase. that way if somebody along the way says "We don't have this paper" then I can say "well, let me help you out there because I just happen to have a copy of it." And that way I'm not dependent on having to call Dr's offices to get copies of things AGAIN or waiting on them to fax things.

It may be too late for that now, but if you find yourself having to gather up papers again I'd make a copy and keep a file going for myself.

[adagray 1]

It may be annoying, but I bet you will come out of this w/an approval. Looking on the bright side, this would never go to a medical director for approval if there was any other reason they could use to deny you. And, I believe that there is no contraindication between Crohn's disease and lapband. There was a lady in my support group (pre-surgery) who had Crohn's disease and preparing for surgery. She happened to mention that she chose the band (instead of RNY and sleeve) because she has Crohn's disease so it was her only option.

The typical folks who work at the insurance companies aren't that educated about the differences between the various bariatric surgeries. So, Crohn's is probably a 'red flag' that gets it sent to the medical director for review. Once they realize there is no contraindication, it should be approved. Yes, they might make you jump through a couple more hoops to prove your PCP and surgeon know you have Crohn's disease. But, BCBS is usually one of the better insurances (in dealing w/people fairly) so hopefully this won't take too long to resolve.

Honestly, though, if that is the only extra hoops you have through this whole insurance process, consider yourself lucky. I had two denials, did two appeals, and it ended up taking an extra 4 months (on top of the 6 month diet) before I was approved. It was all worth it, though. :->

[newmein10 0]

:confused:what state are u in? is it a covered benefit? some of the Blues are strict on what they will/not cover.