Thursday, July 18, 2013

BCBS-TX, and the fight begins.....

So, My broker put me in contact with an employee in the small group department at BCBS because I want to file an appeal.  She's is saying basically that all fully insured contracts with BCBS has this limitation and exclusion and that it will basically be denied (my appeal). 

We went back and forth for a bit. She had already told me this last week, but my purpose in the email was to find out how to file an appeal. So here we go again.  I basically said:

"I want to appeal even if it is denied because I want to bring awareness.  I fought Aetna in 1998 when they didn’t want to cover a reconstructive surgery because it was excluded.  I won.  I’m not saying I will win this one, but I will shake some shoes just so they can review for future years – especially with Obesity being classified as a disease.  Since that became official, then insurance really does not have the right to exclude it – just like any other disease.  So, I want to try to make a difference."
I am not sure if she realized that when I get determination, I can rest until someone wins.  I may not win, but I will never know if I do not try right?
So my question is to some of you who have been studying the recent obesity news where the AMA officially classified obesity as a disease:  How will this affect health Insurance?  If Alcoholism is a disease and just about every carrier out there covers it, should obesity be covered?  AND, what about with Obama care?  How will that impact it.  I want to talk smart in my appeals letter so ANYONE who can provide helpful tips please post or email me at
Thanks so much!!

Here we go, are you ready for a rodeo?????