Guest guest Posted June 25, 2001 Report Share Posted June 25, 2001 Hi All; Has anyone considered the potential strength of joining forces and filing a Class Action Law Suit against Blue Cross? If this new policy of theirs is nation-wide, it stands to reason that folks from every state can join in. First of all, an insurance company has to establish the fact that a requested procedure is in fact, 'Investigational'. Typically, the literature that is used for this purpose is more than 10 years old! Someone posted the entire list of research studies that their insurance company was using to deny benefits and the DS literature was from 1989, 1990 and maybe one study from 1991. I think these might be directly from the NIH web site. The Rny studies, on the other hand were from 1994 - 1997. Obviously something is skewed against our side. On the Insurance list, I advised someone to get more current studies from Dr. Hess (he's got a 10 year study), and to contact the ASBS for more current data. There are several Blue Cross members on the Dr. list who are contemplating a class action law suit. If you have Blue Cross through your employer, there's also the thought of filing a Complaint with the EEOC. The rationale being that Blue Cross is discriminating against the Super Morbid Obese (those with a BMI over 50). They offer medical treatment for the exceptionally thin (anorexics); they offer medical treatment for the obese (Rny for BMI 30-49). But, the one medical treatment that is indicated for the Super Morbidly Obese is available but they refuse to cover it. Personally, I think both lines of attack should be tried and I think Walter Lindeman (spelling?) is the guy to do it. I know that he does take on Class Action Suits. What do others have to say? gobo Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 25, 2001 Report Share Posted June 25, 2001 For what it is worth Dr. Dennis Jr. in Marietta GA just mentioned another study presented at the ABSA conference in June of this year. You can find it by searching the archives of the _ASG group. Hope it helps. > Hi All; > Has anyone considered the potential strength of joining forces > and filing a Class Action Law Suit against Blue Cross? > > If this new policy of theirs is nation-wide, it stands to reason that > folks from every state can join in. > > First of all, an insurance company has to establish the fact that a > requested procedure is in fact, 'Investigational'. Typically, the > literature that is used for this purpose is more than 10 years old! > Someone posted the entire list of research studies that their > insurance company was using to deny benefits and the DS > literature was from 1989, 1990 and maybe one study from 1991. > > I think these might be directly from the NIH web site. The Rny > studies, on the other hand were from 1994 - 1997. Obviously > something is skewed against our side. > > On the Insurance list, I advised someone to get more current > studies from Dr. Hess (he's got a 10 year study), and to contact > the ASBS for more current data. > > There are several Blue Cross members on the Dr. list > who are contemplating a class action law suit. > > If you have Blue Cross through your employer, there's also the > thought of filing a Complaint with the EEOC. The rationale being > that Blue Cross is discriminating against the Super Morbid > Obese (those with a BMI over 50). They offer medical treatment > for the exceptionally thin (anorexics); they offer medical treatment > for the obese (Rny for BMI 30-49). But, the one medical treatment > that is indicated for the Super Morbidly Obese is available but > they refuse to cover it. > > Personally, I think both lines of attack should be tried and I think > Walter Lindeman (spelling?) is the guy to do it. I know that he > does take on Class Action Suits. > > What do others have to say? > > gobo Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 25, 2001 Report Share Posted June 25, 2001 Gobo.... I don't know diddly about the law but I do think this is a great idea. My DS was covered by Blue Cross and it saved my life. I'm 7 months post-op now, down 120 pounds (out of 200 to lose) and I can't believe they are now denying this procedure which they previously approved within 24 hours! I had to drop my Blue Cross and go back to Kaiser (ugh!!!) due to the price of the premium. I am in the midst of job and house hunting but I'll do whatever I can with my limited time to help other Blue Cross patients get this life-saving surgery. H --- gobo yoemoe@...> wrote: > Hi All; > Has anyone considered the potential strength of joining forces > and filing a Class Action Law Suit against Blue Cross? > > If this new policy of theirs is nation-wide, it stands to reason that > > folks from every state can join in. > > First of all, an insurance company has to establish the fact that a > requested procedure is in fact, 'Investigational'. Typically, the > literature that is used for this purpose is more than 10 years old! > Someone posted the entire list of research studies that their > insurance company was using to deny benefits and the DS > literature was from 1989, 1990 and maybe one study from 1991. > > I think these might be directly from the NIH web site. The Rny > studies, on the other hand were from 1994 - 1997. Obviously > something is skewed against our side. > > On the Insurance list, I advised someone to get more current > studies from Dr. Hess (he's got a 10 year study), and to contact > the ASBS for more current data. > > There are several Blue Cross members on the Dr. list > who are contemplating a class action law suit. > > If you have Blue Cross through your employer, there's also the > thought of filing a Complaint with the EEOC. The rationale being > that Blue Cross is discriminating against the Super Morbid > Obese (those with a BMI over 50). They offer medical treatment > for the exceptionally thin (anorexics); they offer medical treatment > for the obese (Rny for BMI 30-49). But, the one medical treatment > that is indicated for the Super Morbidly Obese is available but > they refuse to cover it. > > Personally, I think both lines of attack should be tried and I think > Walter Lindeman (spelling?) is the guy to do it. I know that he > does take on Class Action Suits. > > What do others have to say? > > gobo > > > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 25, 2001 Report Share Posted June 25, 2001 Its a great idea...and one thing that was mentioned that was wrong..not all the state offices of BC/BS pay for RNY. In WA. they pay for NOTHING obesity related no matter what..but as you said...f you're to thin...they have no problem. My dr also mentioned they pay for a gastric sugery for bleeding ulcers which is similiar to the RNY> AJ > > Hi All; > > Has anyone considered the potential strength of joining forces > > and filing a Class Action Law Suit against Blue Cross? > > > > If this new policy of theirs is nation-wide, it stands to reason that > > > > folks from every state can join in. > > > > First of all, an insurance company has to establish the fact that a > > requested procedure is in fact, 'Investigational'. Typically, the > > literature that is used for this purpose is more than 10 years old! > > Someone posted the entire list of research studies that their > > insurance company was using to deny benefits and the DS > > literature was from 1989, 1990 and maybe one study from 1991. > > > > I think these might be directly from the NIH web site. The Rny > > studies, on the other hand were from 1994 - 1997. Obviously > > something is skewed against our side. > > > > On the Insurance list, I advised someone to get more current > > studies from Dr. Hess (he's got a 10 year study), and to contact > > the ASBS for more current data. > > > > There are several Blue Cross members on the Dr. list > > who are contemplating a class action law suit. > > > > If you have Blue Cross through your employer, there's also the > > thought of filing a Complaint with the EEOC. The rationale being > > that Blue Cross is discriminating against the Super Morbid > > Obese (those with a BMI over 50). They offer medical treatment > > for the exceptionally thin (anorexics); they offer medical treatment > > for the obese (Rny for BMI 30-49). But, the one medical treatment > > that is indicated for the Super Morbidly Obese is available but > > they refuse to cover it. > > > > Personally, I think both lines of attack should be tried and I think > > Walter Lindeman (spelling?) is the guy to do it. I know that he > > does take on Class Action Suits. > > > > What do others have to say? > > > > gobo > > > > > > > -------------------------------------------------------------------- -- > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 26, 2001 Report Share Posted June 26, 2001 All state BC/BS policies have individual plans that cover WLS and those that do not - it all depends on the policy that was purchased. Unfortunately, the policy that is least expensive for employers denies coverage for WLS. BC/BS of WA does have insurance plans that cover the RYGB - however most companies in WA choose not to purchase this option. BC/BS only defense against the discrimination of the severe obese (a.k.a. Americans with Disabilities Act) is that they claim they are in compliance and it is the employer who chose not to purchase a plan with such coverage. Hope this helps - G. Woodward, MPH, LCEP Live Light, Program Director Gulf Coast Medical Center Biloxi, MS 39531 1- www.gulfcoastmedicalcenter.com Re: Challenging Blue Cross Its a great idea...and one thing that was mentioned that was wrong..not all the state offices of BC/BS pay for RNY. In WA. they pay for NOTHING obesity related no matter what..but as you said...f you're to thin...they have no problem. My dr also mentioned they pay for a gastric sugery for bleeding ulcers which is similiar to the RNY> AJ > > Hi All; > > Has anyone considered the potential strength of joining forces > > and filing a Class Action Law Suit against Blue Cross? > > > > If this new policy of theirs is nation-wide, it stands to reason that > > > > folks from every state can join in. > > > > First of all, an insurance company has to establish the fact that a > > requested procedure is in fact, 'Investigational'. Typically, the > > literature that is used for this purpose is more than 10 years old! > > Someone posted the entire list of research studies that their > > insurance company was using to deny benefits and the DS > > literature was from 1989, 1990 and maybe one study from 1991. > > > > I think these might be directly from the NIH web site. The Rny > > studies, on the other hand were from 1994 - 1997. Obviously > > something is skewed against our side. > > > > On the Insurance list, I advised someone to get more current > > studies from Dr. Hess (he's got a 10 year study), and to contact > > the ASBS for more current data. > > > > There are several Blue Cross members on the Dr. list > > who are contemplating a class action law suit. > > > > If you have Blue Cross through your employer, there's also the > > thought of filing a Complaint with the EEOC. The rationale being > > that Blue Cross is discriminating against the Super Morbid > > Obese (those with a BMI over 50). They offer medical treatment > > for the exceptionally thin (anorexics); they offer medical treatment > > for the obese (Rny for BMI 30-49). But, the one medical treatment > > that is indicated for the Super Morbidly Obese is available but > > they refuse to cover it. > > > > Personally, I think both lines of attack should be tried and I think > > Walter Lindeman (spelling?) is the guy to do it. I know that he > > does take on Class Action Suits. > > > > What do others have to say? > > > > gobo > > > > > > > -------------------------------------------------------------------- -- > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 26, 2001 Report Share Posted June 26, 2001 BC/BS in WA has paid many times for RNY and DS. The policies (many different companies including BC/BS) that the State of Washington buys for their employees all exclude weight loss surgery and obesity care. I can't understand why the WA state employees union does not take this on. This exclusion was the reason my daughter went to Spain for her DS. My BC/BS paid for mine. in Seattle ----- Original Message ----- > Its a great idea...and one thing that was mentioned that was > wrong..not all the state offices of BC/BS pay for RNY. In WA. they > pay for NOTHING obesity related no matter what..but as you said...f > you're to thin...they have no problem. My dr also mentioned they pay > for a gastric sugery for bleeding ulcers which is similiar to the RNY> > > AJ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 26, 2001 Report Share Posted June 26, 2001 I would be interested in finding out more about this. Darlene from Maine Darlene Pre-op BMI 49 waiting ????? whats up with BC/BC????? Challenging Blue Cross Hi All;Has anyone considered the potential strength of joining forces and filing a Class Action Law Suit against Blue Cross? If this new policy of theirs is nation-wide, it stands to reason that folks from every state can join in.First of all, an insurance company has to establish the fact that a requested procedure is in fact, 'Investigational'. Typically, the literature that is used for this purpose is more than 10 years old! Someone posted the entire list of research studies that their insurance company was using to deny benefits and the DS literature was from 1989, 1990 and maybe one study from 1991.I think these might be directly from the NIH web site. The Rny studies, on the other hand were from 1994 - 1997. Obviously something is skewed against our side.On the Insurance list, I advised someone to get more current studies from Dr. Hess (he's got a 10 year study), and to contact the ASBS for more current data.There are several Blue Cross members on the Dr. list who are contemplating a class action law suit. If you have Blue Cross through your employer, there's also the thought of filing a Complaint with the EEOC. The rationale being that Blue Cross is discriminating against the Super Morbid Obese (those with a BMI over 50). They offer medical treatment for the exceptionally thin (anorexics); they offer medical treatment for the obese (Rny for BMI 30-49). But, the one medical treatment that is indicated for the Super Morbidly Obese is available but they refuse to cover it.Personally, I think both lines of attack should be tried and I think Walter Lindeman (spelling?) is the guy to do it. I know that he does take on Class Action Suits.What do others have to say?gobo---------------------------------------------------------------------- Quote Link to comment Share on other sites More sharing options...
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