About 150lbs overweight & Waiting for Approval

[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

[troxygrl929 0]

I started my journey at 292 and had a BMI of 50 and also have no comorbidities. I also have Blue Cross Blue Shield. I was approved within 1 week of submission. Nowadays it seems like the insurance companies would prefer to pay for surgery than have to fork out more money in the end with the high cost of obesity. That's all I can really tell you.

[SpideyMom 1]

BCBS is usually very good about paying for the surgery. The usual wait time, according to my physician's assistant, is up to 4 weeks for them. You may have to have the PA nudge them a little with a call every week. That's what my PA says she does for all her cases.

Good luck! :thumbup:

[Erin Marie 0]

I was around that BMI when I started trying to get approval. I also had no comorbidities, but both my parents were diabetic and I was pre-diabetic.

I had a year long insurance battle trying to get them to read the paperwork that the surgery was indeed considered medically necessary and not just a vanity thing :/. I had Aetna and the whole ordeal made me very bitter towards them. They kept claiming I hadn't done this part of the procedure or that when I HAD so my office had to keep sending them the information. The Bariatric Center's lawyer had to step in!

It sounds like you qualify though, and they can't really turn you down if you qualify and your doctor says it's medically necessary. They kind of have to put up or shut up. They just don't want to and stall for as long as they can. Eventually you'll get approved.

Edited March 2, 2010 by Erin Marie