stessed about approval

[srinehart 0]

Hello,

I have sent in the needed paperwork to BCBS of NC and today 10-6-10 my surgeons office got a call from the insurance office questioning my 2008 and 2009 weights and requested me to have thyroid test. Thankfully I've already had this done and faxed over the information today. My worry is that they will deny me because of the weights.

To qualify I need to have a bmi of over 40 for the at least the previous 2 years or a bmi 35 with co morbitities. I have no other health issues.

I went on adipax at the end of 2008 and in 2009 dropped to 207 only to go back up to 218 in Oct 2009 (not documented in PCP notes though) So I don't know what there questioning and haven't heard back from the surgeons office and I'm going crazy thinking about it. Anyone had anything like this happen. :thumbdown: Do you think they may still approve me????

[LapBandBobbi 8]

I have FEP BCBS and they approved me right away without question. I had Humana a couple years ago and got denied. I think BCBS is a little quicker to approve. Good luck to you!

[alilbittyna 0]

I have Aetna and was in the same position as you. My BMI was like 38/39 and I had no comorbidity issues. They tried the three month approval and schedueld me for April 21st, nothing, then found out I had to do the 6 month requirement, Next surgery date June 9th, nothing, pushed and pushed. Finally broke through and spoke to an appeals nurse at Aetna who cared. She looked at my file and saw it was missing one piece of information. I quickly called my Dr. office, got the paper faxed to me, faxed it directly to her and she walked it to the manager handling my case. Then my case went for an external surgeon review (WHATT???), finally in late July I got notification of approval and had my sugery August 25th. I started this whole process in Oct 2009!!! I did it though and I have no regrets that I did. I am 6 weeks post op and down 26lbs already!!!

Have faith and keep pushing. If they require more info from your doctor you stay on top of him until it is sent in proper format. The insurance companies do not want to pay for this surgery and they will push it off as long as possible hoping that maybe your policy will end or you will give up trying. Dont give up!!!! Push hard and dont take no for an answer.

[samomom 19]

I don't know what each insurance company requires. I saw the doctor for the first time on Sept 14th and was approved the next morning with the insurance nurse asking the office staff just one question. Just had surgery on Sept 28th, so I had a two week turn around which is unheard of. They had never gotten a approval that fast, ever! It will depend on your police as well. Just because one person with Aetna got denied doesn't mean that the next person will even if they have the exact same weight and medical history. It depends on what your specific policy covers. I have BCBS and my husband's company brags about how great of a policy they offer us and they have every right to. We have amazing insurance that I will never have issues with. But the guy down the street may have BCBS and his employer may not opt to cover the proceedure. Insurance is such a tricky complicated monster.

[srinehart 0]

Hi,

Thank you for your responses. I found out today that I was actually approved!! :thumbup: I'm scheduled for Nov 23rd.

Thanks again