Long sleepless night
Yesterday, I spent some down time at the end of my workday surfing the OH website and message boards (I know, I know). There were several posts from people who were denied for WLS by their insurance companies because their employers had written specific exclusions of WLS into their policies. It dawned on me that I had never called Blue Shield to see if my HMO policy had an exclusion in it. It dawned on me at 5:02pm. After Blue Shield was closed. I spent the next 16 hours freaking out at the thought that I could be denied. It was a very long night. Of course, this awful heat wave and the fact that we don't have a/c didn't help. Thankfully, I got ahold of BS this morning and confirmed that my policy does not have a WLS exclusion in it. I had my HR rep forward me a copy of the entire policy and there is nothing excluding WLS, although it has to be determined to "medically necessary".
Some good news - I will get the results of my overnight sleep study tomorrow morning. My original appt wasn't until September (sleep dr. on vacation for the month of August), but they had a cancellation - yea!! That should help speed the process along nicely!
posted by Danyele @ 11:57 AM
3 Comments:
A sleep study? Here's hoping you've got Sleep Apnea. It's the Golden Ticket! It's a bizarro world we live in when we're all happy to have a medical condition but the unfortunate truth is, it gets the approval DONE. I had rising blood sugar. SCORE!
I had BCBS. Try asking if you can get a third-party reviewer if you are denied. That's what clinched it for me.
I had my sleep study and first treatment done. I actually pick-up my c-Pap machine this week. :)
Good luck, and no stressing!
Donna :)
Hey!
When it comes time for your MD to prepare and send your letter of medical necessity to the evil insurance company, if you want I can forward you the a pretty good comprehensive med. ltr. template. I used it as a guide and it covered everything those bastids wanted!
:) KT
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