NCHope

Hello, My insbcbs) has denied me 2x. 1st when my information was sent in and 2nd when the doc. did the peer to peer. I am trying to do an appeal and my case manager wants to know if I want to write a letter to send in with it. Does anyone have an appeal letter(that worked) that I can get some ideas from? bmi - 38 Co-morbidity - moderate sleep apena - ins. says it has to be severe sleep apena. I had irregular heart-beats and my oxygen level was very low, guess it wasn't low enough. other problems that ins. does not care about - depression, joint pain, high cholesterol, fatty liver. Just don't know how to start the letter and am so upset and down I can't even think right now. Thanks for any help.

Can I ask how much it cost? and what is included. thanks I have been denied 2x by my ins.

I was denied when my doc. sent in my stuff to ins. (bcbs) I have bmi of 38.5 and moderate sleep apena. My policy on wls says severe sleep apena. I told my case manager and the Dr. this but they said don't worry about it. BCBS is easy and we can get you approved. So I got my hopes up big time! I am $500 approx. out of pocket for all these tests that I would have never had done. I know my doc. office can't garuntee me anything but they do this all the time and I got fooled! My doctor did the peer to peer today and was still denied. What should I do now? I am so upset and discouraged. How much is Mexico? Does it include airfare? thanks

Well I have just been denied. I am so upset, I didn't realize how much I had my hopes up. I have rushed myself to death getting every little thing that ins. needed. I have a bmi of 38, high cholesteral, moderate sleep apnea, fatty liver, joint pain. I'm going to get in the bed and have a good cry!

9th working day still waiting also. I'm going to call ins. this afternoon and probably hear the same thing. "It's still being reviewed"

I am also your same weight and height. This is the 8th working day that ins. has had my information. I can't hardly stand the wait. I have BCBS and my surgeon's office says they have seen people with lower weight be approved. So I still have hope. I also have sleep apeana (sp?). I have been calling my ins. co. I'm embarrassed to admit.

Why did they deny it at first and what did you do to get them to approve it? thanks

I have been calling and found out that it has been sent to the doctor for review. I don't know if this is a good or bad thing.

Hello, I have anthem ins. and bmi of 38 with sleep apnea. I am on my 8th day of waiting for approval. I can hardly stand it! Does anyone know if anthem is the same as bcbs? When I call anthem they are in Georgia does that mean I have anthem of Georgia even though I live in another state? Just wanted to see if anyone has a similiar situation. Thanks!

Hi, I have a bmi of 38 with sleep apnea. My policy states that I only have to have 1 co-morbidity. I'm on my 8th day waiting for a response. Anyone else have any experience with this? thanks

I'm in the same boat with you all. This is the 7th working day that I have been waiting. I have anthem ins. Anyone have anthem with a low BMI 38? Would like to know your experience. I must admit I have been calling them. What are they going to do tell me not to call anymore?

It's the liquid Diet I'm scared to death of!!!!! I called my ins. today and they said that I should have an answer this week. I have to do the 2 week before and 2 week after surgery. I do not like even the smell of Protein shakes. I don't know what I'm going to do. My engery is already low. I feel like if they do approve me I'm not going to be happy because I don't think I can do this liquid thing. Any ideas? thanks

Hello, My case manager has just sent my stuff to my ins. for approval this week. I am so nervous about it. I was just wondering how does the ins. notify me? I was told that a letter would be sent to my doctor and myself. Surely they have a quicker way than that. I have read where people have been approved in 24 hrs. How is that possible? Does the case manager just scan the forms in and email it to the ins.? I know the ins. recieved it in one day. I have anthem BCBS. Don't really know what state, it's not the state I live in. Thanks

Oh I see you are bcbsnc, I am bcbs athem. They only require 1 co-morbidity under 40bmi. I have sleep apnea. Hope everything goes well with your surgery!

Bratt1345, Just read your response. I have bcbs athem. I have their policy printed out on weight loss surgery and it doesn't say that they need a history, which I don't really have. So now I am concerened that this will hold up the process. Did you read your policy and it said that or was that something they just came back with? thanks Also seeing Dr. Enochs - Sleeve.