BMI - Insurance Question

[sophinator 2]

Okay...after waiting a month and a half for my consult appointment I go in for a 2 hour appointment where they take my picture, the dr. spends tons of time explaining the procedure to me (most of which I already knew because of this board and watching the surgery on youtube...but I listened patiently because every dr. is different and I need to know what he does) they sent me up for an ekg .....................after all that.....................I am 7/10ths under the 40 bmi. I am 3lbs away from what I needed to be. I have always said I am 5'4" and the nurse measured me at 5'5"! So now I am in the waiting portion to see if my insurance will pay for it...and hoping I have not gotten my hopes up for nothing. 3 lbs difference!!! The dr. said since I have borderline high blood pressure and acid reflux he will add that in his report but I don't have any comorbities other than that. I have already done the nutrition appt. and the psych appt....Will they really reject me for 3 lbs...that I could have drank Water to gain before my appt? I have Anthem Blue Cross Sisc ...needing postive insight...feeling a little frustrated

[Lil Ol Me 0]

I was under my BMI much more than you are and I have Anthem too. I was approved with 2-3 weeks. Health issues make a difference. The measured me an inch taller than I thought I was too. Good Luck! By the way I'm scheduled for surgery on Jan. 7th.

[mattie7632 24]

It's hard to say, but I'm betting it goes through. I own a medical billing service billing health insurance for a living, and let me tell you one thing...doctors are experts at documenting what is needed to get approval. Their salaries depend on it. If your insurance doesn't approve you right now, stuff your face with cake and chips, gain 5-10 pounds and go back in a month and have them try again!!! That's what I'd do!!

Okay...after waiting a month and a half for my consult appointment I go in for a 2 hour appointment where they take my picture, the dr. spends tons of time explaining the procedure to me (most of which I already knew because of this board and watching the surgery on youtube...but I listened patiently because every dr. is different and I need to know what he does) they sent me up for an ekg .....................after all that.....................I am 7/10ths under the 40 bmi. I am 3lbs away from what I needed to be. I have always said I am 5'4" and the nurse measured me at 5'5"! So now I am in the waiting portion to see if my insurance will pay for it...and hoping I have not gotten my hopes up for nothing. 3 lbs difference!!! The dr. said since I have borderline high blood pressure and acid reflux he will add that in his report but I don't have any comorbities other than that. I have already done the nutrition appt. and the psych appt....Will they really reject me for 3 lbs...that I could have drank Water to gain before my appt? I have Anthem Blue Cross Sisc ...needing postive insight...feeling a little frustrated

[sophinator 2]

Thanks for your replies...I'm not getting my hopes up but am definitely hoping for an approval. Best wishes on the surgery Kathy...may I ask...did you have other issues that helped with your approval?

Mattie...I'm hoping you are right. I even said to the dr...if my appointment had been later and I'd had coffee and Breakfast this would be a non issue. I had the stomach flu two days before my appointment so that definitely didn't help. I just wonder if I go back and weigh in 5lbs more in a month would they approve it or would they say no based on they know I gained it just to make the limit...grr. I guess I will just have to wait and see. Thanks for your replies and best of luck to you both!

[mattie7632 24]

Hopefully your Dr. documented that you'd been sick and your weight is down as a result. Let us know the outcome!

Thanks for your replies...I'm not getting my hopes up but am definitely hoping for an approval. Best wishes on the surgery Kathy...may I ask...did you have other issues that helped with your approval?

Mattie...I'm hoping you are right. I even said to the dr...if my appointment had been later and I'd had coffee and Breakfast this would be a non issue. I had the stomach flu two days before my appointment so that definitely didn't help. I just wonder if I go back and weigh in 5lbs more in a month would they approve it or would they say no based on they know I gained it just to make the limit...grr. I guess I will just have to wait and see. Thanks for your replies and best of luck to you both!

[lacjim 0]

If you are denied, make sure you file an appeal. I was denied because my Dr didn't list my co-morbidity and my BMI was 36. I sent an appeal letter with a letter from my gp about the co-morbidity and it was approved. Funny thing,, it was denied in 1 day and they took 32 days to review and approve. Do you think they thought I would just go away??? BTW, my surgery is scheduled for January 12th.

[mattie7632 24]

oh I'd like to say I'm surprised about the 32 days, but I'm not! Just wait, if/when national healthcare happens, this sort of thing will only get worse. It's already started just the average joe doesn't realize

If you are denied, make sure you file an appeal. I was denied because my Dr didn't list my co-morbidity and my BMI was 36. I sent an appeal letter with a letter from my gp about the co-morbidity and it was approved. Funny thing,, it was denied in 1 day and they took 32 days to review and approve. Do you think they thought I would just go away??? BTW, my surgery is scheduled for January 12th.