bummed - got my denial

[Guest guest]

Well, I finally got my denial from BCBS of Texas. The thing that makes me

mad is that I cannot appeal unless I actually have the surgery first. I

don't even get a stinkin' second chance to argue, lol!!! AND the kicker is

that my first request ( " pre-determination " ) never even got reviewed by a

medical person. The customer service reps are informed to refuse ANY request

for WLS and not to even send it to a medical review committee - they

automatically stamp it " refused " .

My insurance is hiding behind a rock-hard and yet extremely vague and

ambiguous exclusion policy. <<SIGH>>

I even contacted my employer's insurance coordinator (State of Texas) and

they claim that they HAVE to stand by the exclusion. To them (and BCBS) this

surgery falls under the description of a weight loss program.

If I were a drinker, I'd be drunk about now, lol. <<<<<<<<SIGH>>>>>>>>>

I'm not quite sure where to proceed.

Kathie

[Guest guest]

>

> My insurance is hiding behind a rock-hard and yet extremely vague

and

> ambiguous exclusion policy. <<SIGH>>

Same exact thing happened to me. I appealed three times and went

before the board, did not matter, they stood behind their exlusion

all the way, why wouldn't they, if they legally can? They don't care

about you, they care about saving money. Can you look into self-

paying? Get a loan or tap into your home equity, go to Spain or

whatever. If you can find a way to fund the surgery then go for it,

I wouldn't waste a lot of energy on trying to get approval, put that

energy toward finding the money to self-pay. That's my .02.

7 months post

-97.