Insurance won't review file-Help

Makes_Pretty_Babies · 10-30-2009, 08:16 PM

I have been working on my file since beginning of September and it was finally submitted to BCBS TX 10/22. Today they informed me that they won't even review my file regardless of my multiple comorbidities due to exclusion. My Dr. said they will appeal and they are positive I will win on approval. However, the Insurance company states nothing will change their decision. I have been fighting my weight forever, so waiting won't change much. But am I fighting a battle with them that I can't win? Any help or information is much appreciated.

WAITING.......

MandaPanda · 11-05-2009, 04:51 PM

So sorry you're having a hard time.

I'm still in preband land but after reading many of the posts on this site, it seems you may out of luck. If your insurance actually has a policy exclusion saying it does not cover WLS, then an appeal probably won't help. If they're denying based on the criteria, then your doctor can probably get the decision overturned. From my understanding, it isn't the insurance company that determines the policy exclusions, it's the employer. I've heard some say their companies have an employee advocate that can sometimtes help in these situations. I'm glad your surgeon isn't giving up. Not all of them are so helpful. Good luck to you and please keep us posted!

Makes_Pretty_Babies · 11-05-2009, 06:31 PM

Unfortunately that is probably true. We are in talks with my husband's company at the moment, but so far no good news. We pay bucko $ in premiums a year-you think we would have a little more power in these things. Thanks for the encouragement! Will keep you updated.