Blue Cross of California

[ReneBean 3]

Inamed has a "hotline" that your doctor can use to get additional support for an appeal if your insurance has been denied. Have your doc e-mail

Laura.Zamarron@inamed.com

once you get your first denial. This service is FREE in the interests of beating the insurance companies into submission for future Bandsters.

The hotline number is ONLY available to your doctor - not to you or anyone else.

We'll see how it goes.

[NJChick 3]

Thats retarded !!! any weight loss has got to be better than gaining or no weight loss. I'm sorry this is happening to you Beanie, but I'm glad your fighting them. You go girl

[ReneBean 3]

UPDATE:

I reviewed the Inamed bibliography - which was current thru 2004 - and have researched to find more current documented studies to combat the BMI issue and the Investigational issue. I am submitting my own appeal. If I have to go to the insurance board, I will get help for that.

I have posted the study references in the sticky thread:

http://www.lapbandtalk.com/showthread.php?t=2527

:]

[ReneBean 3]

More on the inner workings of Blue Cross... Any written communication that you send them, either by e-mail, fax or post, gets scanned and linked to your computer file at Blue Cross - so anybody who accesses your file can actually see what communications have been received.

This process takes from 2-3 days - which means that you cannot get anybody to acknowledge receipt of anything specifically for that time frame...

So, you can tell that SOMETHING has been sent for imaging - but not what that something is. With written communication, less may be more at Blue Cross, unless you are EXTREMELY patient...

grrrr

[ReneBean 3]

Well, our friends at Blue Cross have denied the first appeal - again, because my BMI is over 50 - despite the studies referenced showing that there is no difference in the final result of the surgeries. Now I have to either retain a very expensive attorney to rush a review request to the State Insurance Board of California - or I have to take another risk and submit to them, myself.

Did anybody submit to the State of CA Insurance board without attorney assistance and win? Please advise.

Thanks!!

Irene

[aaamom 0]

I'm so sorry you are going through this. I have no advice to give you on this matter other than to KEEP FIGHTING !!! It appears that alot of bandsters here have appealed an won. Let's hope that you are one of many who can beat the insurance company at their game ! Good Luck

[steve425c 0]

If you do end up having to pay for it yourself, it is deductible on your Income tax for the year...................

[ladysplenda 1]

When I got turned down I called and asked to speak to a manager. She helped me get approved.Have you tried talking to a manager?I was told you could only appeal three times in a year.

[ReneBean 3]

Howdy Folks,

The saga continues... In case you're just tuning in, I have been denied and my appeal to Blue Cross has also been denied. Well, today I sent my packet off to the state of California Insurance Board for an independent medical review.

Maybe I am just pissing in the wind, here, because my policy with Blue Cross changes as of January 1 - and I really don't know if there is a company exclusion being added or anything. Hopefully, the change in policy will only mean that I have to pay more than I would have before...

But, if Miracles happen, maybe somebody at the State Insurance Board will have a heart, give a damn, and get right on it.

If they review QUICKLY, I could still get in under the wire on the current policy, and only have to pay 20% - vs 30% next year.

Everybody keep your fingers crossed. The package will be delivered on the wings of Fed-Ex tomorrow morning.

Please note, I would have filed my request much sooner, but our friends at Blue Cross did not bother to mail the denial letter until 3-4 days after the verbal denial - and it did not arrive until after I left on my vacation. Have I mentioned how much I love BC/BS of California, lately?

After Jan 1, I feel like I will have to start ALL over. :[

Everybody think good thoughts.

[zone6 0]

I would be considered a newbie here, but I'd like to give some hope to others that have BCBS of California....

Im 26, 5'4, 232lbs...went to my first seminar on Dec. 3, 2005 after my job notified us that our insurance would be changing as of JAN 1...much to my surprise to a United HC plan that WOULD NOT cover the lap band surgery. So here it was i week into dec. and i had to get things rolling if i wanted any chance at being slim in the new year! At the seminar I was told that BC of Cali was mandated and that they HAD to cover the surgery; all i needed was a psch consult, and 1 visit with the dietician. So I had my psych eval on 12/8 and met with the dietician on 12/12. When I called the surgeon's office, they told me they mailed my letter of medical necessity on 12/7. I was thinking, WHAT??!! I couldnt believe they snail-mailed something so important. But there was still hope....

After hanging up with them, I got on the phone to BC of California pre-cert dept and asked them what their approval process was and if it was possible for the doctor's office to just fax everything over. Answer: YES. The rep gave me the fax # and i called back to the doctor's office and gave them the fax so that they could fax ALL of my papers to BC of California. I also had the doctor's office fax ME the confirmation that they faxed it to the insurance, so I would have something to go on when checking back with the insurance company everyday. So, all of my data was in the BC system on 12/19 and every rep that I spoke to told me that they have 30 days to make a decision. Well here's the key....I told them that I didnt have 30 days, because I was already given a surgery date of 12/29 and that I needed it approved by then. And wouldn't you know, my surgery was approved on 12/21!!!! and yes I just had my surgery on 12/29 and am in the recovery/liquid diet phase, all in the course of 1 month. Hope this is helpful to someone else...

[sleepyjean 0]

I can't even tell you how much hope you have just given me. God bless!

Rene - did they say it's *just* because of your BMI? That's bullcrap. I hate the health insurance industry.

(By the way, thanks for posting the BC policy a while back. It was good to have that to read over.)

[ReneBean 3]

Yes - it's true. According to BC/BS, I am too fat for the Lap Band.

Zone6, so glad it worked out better for you.

Good Luck with your Band!

:]

[ReneBean 3]

Rene - did they say it's *just* because of your BMI? That's bullcrap. I hate the health insurance industry.

(By the way, thanks for posting the BC policy a while back. It was good to have that to read over.)

Yes, it was bullcrap - and the State of CA agreed...

Hey Guys.

I fought my own battle - did my own research, wrote my own letters, and after a second denial of coverage by Blue Cross, I submitted my own package to the State of CA for Independent Medical Review.

I got a verbal today from the State - they have overturned the denial and my procedure is considered 'Medically Necessary' - the magic words that insure coverage. Now, I just have to get past the fact that they have changed my insurance plan at Blue Cross - I surely do hope that I don't have to re-submit!!!

But, if you want to see the letters I sent - feel free to PM me. I will be happy to forward them to you to review.

Please don't give up, just because insurance denies you - It really is worth the fight.

Good Luck!!

Irene

[dolphin_dreams 0]

Rene,

I am thrilled for you. You are such a sweet soul and have been an inspiration to many. I will pray that God continue to bless you and speed along the process. Again, CONGRATULATIONS!!

Kendra