sunshine210

I just received the phone call from insurance and I've been denied. I have anthem BCBS, a bmi of 35.8 with moderate sleep apnea. I've been told my surgeon is going to do a peer to peer with the insurance company but wondered if I have any chance whatsoever of being approved. I wish I'd been told initially to forget it but now I've jumped through all the hoops only to receive this devastating phone call. All pre-op testing was completed, all pre-op appointments are scheduled, surgery is scheduled for 3 weeks from today, protein powder is purchased. Any input or advice is welcome. So very disappointed.

My surgeon did a peer to peer with the medical director at my insurance company and was able to get me approved 2 days after the denial. Apparently they had not received the paperwork that I have HBP. So, I'm on for Dec 3 and beyond nervous.

I'm on the 3rd and am feeling the same jitters. I guess it's normal but doesn't make it any easier. When I saw my nut the last time I asked her if there was anyone she saw who regretted doing the surgery and she said not one, that she would've found a different job if that were the case bc she likes to help people. I think about her statement all the time. Best wishes to you!

A question I forgot to ask and I'm trying to plan for post-surgery. How soon after surgery are we allowed to drive? Obviously it would be once we are off pain meds but when is that usually?

Your post is me! I'm 35 bmi and used to be a marathon runner before kids and I also just want to be able to run and feel like myself again. I've tried everything to lose the weight too but it always creeps back on. Diet after diet after diet. This was really my last resort but I feel it's the only way I'll have success. I was denied by insurance last Wednesday with sleep apnea because its moderate and they wanted severe but my surgeon was able to appeal with the fact that my blood pressure has also been elevated recently and on Friday I was approved! Whew, yeah I think I was right on the borderline and was sweating it out waiting to see if the denial would be reversed. Wishing you success bc I can SO relate.

Was approved today so I'm in for Dec 3!

NJ and its a work plan

...after first being denied? Got the phone call today from insurance that I was denied but my surgeon is appealing with a peer to peer consult tomorrow morning. On pins and needles here...

Saying "medically unnecessary." I've been diagnosed with sleep apnea which is technically my only comorbidity but I have other issues like reflux, joint pain, HPB (non-medicated: she said she wants to wait to see if it comes down with weight loss!), elevated triglycerides... Oh and I'm MISERABLE, it seems your mental health should be considered too shouldn't it?? Btw I'm just above 35 bmi which I guess is working against me. I'm 5'5' and 215 and would like to be 125ish which is still 90lbs away. I know it's not 100s but its still unattainable to me without help. Sigh. Should hear something by this afternoon. Fingers crossed.

Dec 3 (pending insurance approval) for me too! Anxious and excited.