Insurance denial for wls do to pre existing conditions.

**Smokinxb** · 07-11-2011 08:23 AM

I just got BCBS of LA. They don't want to cover my WLS because they say it's pre existing. This makes me so mad. They said I have to wait 365 days before I can do anything. Have any of you ever heard of something like this? We did all our pre opp stuff and now this. I'm wondering if there is a way around this?

**Smokinxb** · 07-11-2011 08:37 AM

They said I had like a 63 day grace period . I passed it by like 6 days. My old company I worked for went out of business and we were bought out by another company by the time they did the change over and everything it had passed a few days.

**cajunbandmom** · 07-11-2011 09:11 AM

I would get my dr. to fight it... it might work. I never tried when we had BCBS LA.. I was so happy when my husbands new job had BCBS TX.

**Smokinxb** · 07-11-2011 09:15 AM

Yeah my Dr. said he was going to call them and talk to them. Keep me in prayer.

**FlowerGalTX** · 07-11-2011 11:11 AM

Are they considering your obesity to be an existing condition? Of course your obesity is a previous condition!!! Geesh, uhm, haven't you've been overweight for awhile and isn't being overweight for awhile part of the typical criteria for approval FOR weight loss surgery?

**Smokinxb** · 07-11-2011 12:17 PM

I geuss when you get new insurance they won't cover anything pre excisting.

**mommyto3** · 07-11-2011 12:18 PM

I'm sorry to hear this. When I signed on with my new insurance in January, I was afraid that I might face the same issue. I was able to prove that there was no lapse in my coverage so the pre existing condition wasn't an issue for me. I'll keep you in my prayers. I hope it's resolved for you soon!!

**Smokinxb** · 07-11-2011 12:49 PM

Thank you. They said I could have 63 days lap and I was a few days passed that. Really makes me upset.

**grammysyd** · 07-11-2011 01:43 PM

These insurance companies are sure the pits for some people. My dr. has several people he employs to deal with all this insurance BS. The dr. staff should get to the bottom of this with you. I'm not saying you won't have to help them or make calls yourself, but usually they have set requirements to pre-approve procedures and if you meet those, there should be no issue. I know I had to jump through LOTS of hoops to get approved with Aetna, but it's all worth it. Keep your goal in mind. I pray it works itself out for you!!!!

**newjoanie** · 07-11-2011 02:15 PM

I had to do the same with aetna - but finally the drs office got it through. Just keep doing everything you are told and you should get to the sx before you know it. I know in January I was told that it would have to be six months and I threw and absolute hissy fit - but the six months passed and I got my surgery and in the meantime working with the nutritionist I lost 40 lbs in the process !

**CountryNana** · 07-12-2011 10:16 AM

I was denied and I appealed. Google appeal for the Gastric Sleeve surgery. There are a lot of examples there. Your insurance company should always give you a chance for appeal. If they deny it again then you should be given the option of going through an independent evaluator. You must do that also. My doctor encouraged me to pursue this to the end and I was sleeved on May 17 and have lost 31 lbs.! You must be dogged in your pursuit of what you want!!!!
I'm praying for you right now as you move forward one step at a time.
Blessings,
Pat

**Smokinxb** · 07-12-2011 10:38 AM

Thank you so much. I've been praying like crazy that the Lords Will Be done. I spoke with my Dr. about this and he said this isn't the first time that they had this issue. I asked him how often he gets it approved. He said every time so far. I'm like ughh.. I don't want to worry. This would be my second time around on trying to get this surgery. The last time I was days away from surgery and the lady asked how I was going to pay I said my insurance she said yes but you have a balance of $3000 do before surgery.... I was like wth ... now you tell me.

**newjoanie** · 07-12-2011 10:45 AM

Remember every day is another day closer to your goal. Do what you know you can do while you wait. Near the end of my time in pre op stage I started worrying that I would lose so much they would deny me the surgery. My last couple of weigh ins I carried stuff in my pockets and wore my heaviest jeans and sweatshirt to be sure that I didn't weigh to light for the surgery. Just keep pluggin toward your goals.

**Nancy Stern** · 07-23-2011 10:42 PM

I would definitely go through the appeal process. Legally speaking I'd would think they would be liable if something were to happen to your health that is weight related while they wait a year before treating you. If you were a diabetic they certainly would not refuse you care for that preexisting condition and didn't they essentially accept your condition when they accepted you as a member. Not to mention Obamacare was suppose to stop them from doing this. Good luck