Chances of Getting Approved??

[xbibixbrownx 0]

Hi Guys,

I am currently playing the waiting game with my insurance company. I have Anthem Blue Cross & Blue Shield PPO. I weigh 315 lbs and have a BMI of 49.3; although, I have no comorbidities. My first submission for approval was denied because the doctor's office made a mistake and submitted my application for surgery without sending in the required mental health evaluation and nutritional evaluation/assesment documentas that are required for the surgery.

After they discovered the mistake, I was told that we would have to go through the appeals process. I was a bit upset because I didn't think it was fair that I was being penalized for something that was the doctor's offices mistake and not mine. Nonetheless, there was nothing I could do. The documents for the appeal were submitted on 2/8/10, and no determination has been made yet.

My questions to you is..

Based on your experiences/knowledge what are chances of getting approved with my BMI of 49.3 and no comorbidities?

Thanks in Advance,

Bibi

[Sue Magoo 71]

It sounds like a slam dunk to me with a bmi that high. However, they may make you do a six month medically supervised diet first.

You may want to reconsider who you're getting banded with if they're not on top of the paperwork. You'll be having a very long relationship with your band surgeon's office staff and it's important that they are attentive. You might want to check out your surgeon on this site and ask questions to people who've gone to him to see that paperwork screw ups are rare.

Good luck and let us know when you hear back!

Sue

[xbibixbrownx 0]

Hi Sue,

Thanks for the reply. I too think that my BMI is really high. The fact that I am in the 300lbs + category in and of itself should make me a really good candidate.

I checked out my surgeon on this website like you recommended, and he has a 5 star rating. I actually did my research before visiting his office and found him to be the best in my area. I was so excited because he is very experienced and has even spoken at national lapband conferences. I don't know what happened as far a the simple but unnerving mistake his insurance specialist made, but I will definitely stay on top of things from now on.

For now, though, I am left here just wondering and hoping...

I'll update once I know anything.

Bibi

[middygirl 0]

I too have BCBS PPO. My surgeon told me that my policy covers the surgery. Now we just have to see if they will cover me. I spoke with my surgeon yesterday and he said that a BMI over 40 is reason enough even with no comorbids. Mine is 45 with no comorbids. I weigh 254 and am 5'4. Hopefully we'll both get the news we want to hear soon!! Good luck!:tongue_smilie:

[xbibixbrownx 0]

Misty,

I am glad that I can share my experience with someone; although, I wish neither had to endure the agony of waiting for the insurance to decide whether or not they will cover.

I post as soon as I know something.

BB

[Vixian 0]

What about people who dont know if they have insurance or not? any suggestions?

[xbibixbrownx 0]

Vixian,

What do you mean by people who dont know if they have insurance or not? Can you explain? If someone doesn't have insurance they would have to pay out of pocket.

BB

[Vixian 0]

Vixian,

What do you mean by people who dont know if they have insurance or not? Can you explain? If someone doesn't have insurance they would have to pay out of pocket.

BB

Ok well i just found out I have IEHP and i dont know much about the insurance and stuff like that so i dont know what a PPO? insurance is... and I was wondering if anyone knew if they would be able to pay for lap-band.