in Seattle

[Guest guest]

In a message dated 9/4/2001 3:06:01 PM Pacific Daylight Time, jenQ@...

writes:

> My name is , from Seattle, and I'm looking into starting the process

> for DS. I have Regence Blue Shield PPO and I know they have an exclusion

> clause but I don't remember if they will override it with a medical

> necessity. I've just scheduled an appointment with my primary care physican

> to make my case to her. I'm very well informed of the proceedure, risks,

> and lifestyle changes such a proceedure requires. I'm sure I will make a

> powerful case, especially with my back problems. You all have been very

> helpful in compiling information.

>

...

Good luck...I also have Regence...I'm sorry to have to tell you this....but

unless you work for Boeing..chances are very slim. I fought them but I work

for a small company and we have the exclusion. I weighed 415 and had other

problems....I completely fit the criteria they have but due to the exclusion

they refused. I even went with medical necessity, I had great letters from my

PCP, therapist, employer etc. NOpe..they said no way. I even brought up in

the booklet it says they can do things on a case by case basis and won't be

obligated to everyone if they choose to pay for something not

included...still nothing. If you find a way to win...then I want to know

how...I have one appeal left and I intend to ding them...but not sure how to

preceed. I am thinking if there is a way to bring a lawsuit I will...They pay

for anorexics and alcoholics who rarely get cured in one visit...but will not

pay for weight loss...which will save them money most of the time. So I went

to Spain and I'm now 6 weeks postop (I cant believe its been that long!!) and

already am saving the insurance money...I'm off all but one prescription!

~*~ AJ ~*~

Age 37 5'8''

Post op 7/24/01 Open BPD/DS

self pay - Dr Baltasar -Alcoy Spain

07/24/01 BMI 64 415.1

08/06/01 BMI 59 390.2 -24.9 lbs!

08/16/01 BMI 58 387.0 -27.9 lbs!

08/24/01 BMI 58 386.5 -28.6 lbs!

08/30/01 BMI 58 378.3 -36.8 lbs!