So you agree she should be denied coverage.
She is definitely in the .01 pct here, but they refused to allow her to debate the appeal.
They require proof of heart condition. No other options.

Is she trying to get ozempic?

Blue Cross denied me an MRI the last year I was on a group policy at work. So far Medicare has denied nothing.

No sir- not if she’s that minor part you describe, hope they reverse the decision for you all.

Sounds like the VA. They have their little sheets with check boxes and if you don't fit the check boxes you are chit out of luck. The bean counters and bureaucracy own the VA and best interest of the patient has no place in the VA system. Luckily there is a Whitehouse hot line for the VA and when you call they open a casefile immediately. You should see the locals jump and piss their panties when an inquiry comes in from the Whitehouse.

Just noticed the Wegovi ad tv has it in the small print about being for a heart condition, never noticed it before.

But it’s free!

She did ozempic, but it caused a rash. She is trying to start up wegovy. Now it will be 500 a month the first year and over 1000 a month after wards.
It should be a copay of 15 bucks.

She has no thyroid, so weight gain is a battle.

Veterans are quick to slam the VA for being terrible, but the truth is, no healthcare system could keep up with what’s been thrown at it. The wars in the Middle East left a massive number of veterans seeking care for real or imagined health issues. That kind of demand would stretch any system to the breaking point. It’s not just about bad management, it’s about a level of need that’s way bigger than the system was built to handle.

Ignoring combat arms veterans, it’s mind-boggling to me that someone can serve just 2-4 years in the military and walk away with lifetime healthcare coverage. The amount of money to keep that promise is enormous.

So many people are scamming the VA now. Example- how the heck can you get a disability rating for appendicitis? Did the military really cause that? You wouldn’t believe the number of folks that live and think every minute trying to get that next 10-20%. It’s designed for true disability that was caused by military service. The system is broken.

I didn't serve and don't feel I earned a seat in this argument, but I would rather error on giving deserving vets their due.

Canada related :

I have a long, long list of horrible healthcare or lack of that my wife's family and her friends families have endured. Horrible decisions and delivery that I have never seen happen in the US. None of that kind of bull.

If you have a cold or flu it's pretty good, if it is serious then and needs interventions, well, good luck . . . especially cardiac.

There's a real good reason why I evacuated Canada in August having an MI and drove 4 hours to get to a US hospital that provided cardiac services. All my knowledge is strictly concerning the Maritime provinces.

Our pastor is in the middle of a fight with BCBS. They won't approve his heart surgery that his doctor says he needs. Socialized medicine sucks and private insurance sucks just as much. I wish we could just go to a system of catastrophic only coverage and you pay for everything else.

Aetna gave my co-worker a hard time for 2 years about covering a defibrillator and resuscitation when his wife bled out and flat-lined on the table after giving birth and the only MD in the area was an anesthesiologist...fortunately the anesthesiologist was able to save her, but insurance wouldn't pay him for over 2 years because they'd never seen an anesthesiologist code for a resuscitation.

But again, socialized medicine isn't any better. It all sucks

We stopped accepting UHC insurance for a period of two weeks last November for this very reason. UHC refused to negotiate in good faith and never thought we would drop them until we called their bluff.

We have such systems- that’s what a high deductible tied to a HSA is.