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Lap Band Denied By Bcbs Very Disappointed

GermaineF

By GermaineF, in Insurance & Financing

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GermaineF    25

GermaineF
Posted

I'm very upset right now b/c for the past 6 months i've been going to the dr and dietician for 6 months straight, saw a psyc, and did Meal Replacements only to find out that I was DENIED!!!! Now get this...they said i as denied b/c i didn't have documentation of 6 months non surgical weighloss, (duhhh i saw dietician for 6 months) and also b/c i only have 1 comorbid (high blood pressure) When i 1st started on this journey, the dr assured me that it wld be no problem for me to get approval with a BMI of 35 and HBP...What am I to do now??? PLEASE SOME HELP ME.....

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FromPrisoner2Pioneer    6

FromPrisoner2Pioneer
Posted

Did you also see your PCP once per month or just the dietician? My bariatric center gave me a form that my PCP had to fill out every month. Plus, I had my PCP scan my food log into my medical record every month. I was approved after six months, but I had 3 comorbidities (HBP, cholesterol & sleep apnea) & a so maybe it had nothing to do with the medical record? And I didn't have BCBS but I dunno...I thought I'd throw it out there... just trying to help?

So sorry!

:(

/P2P

I'm very upset right now b/c for the past 6 months i've been going to the dr and dietician for 6 months straight, saw a psyc, and did meal replacements only to find out that I was DENIED!!!! Now get this...they said i as denied b/c i didn't have documentation of 6 months non surgical weighloss, (duhhh i saw dietician for 6 months) and also b/c i only have 1 comorbid (high blood pressure) When i 1st started on this journey, the dr assured me that it wld be no problem for me to get approval with a BMI of 35 and HBP...What am I to do now??? PLEASE SOME HELP ME.....

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FromPrisoner2Pioneer    6

FromPrisoner2Pioneer
Posted

Also, I've spent some time in Lafayette, Louisiana. I dunno how anyone diets there. You guys have the best food in the world!

I'm very upset right now b/c for the past 6 months i've been going to the dr and dietician for 6 months straight, saw a psyc, and did meal replacements only to find out that I was DENIED!!!! Now get this...they said i as denied b/c i didn't have documentation of 6 months non surgical weighloss, (duhhh i saw dietician for 6 months) and also b/c i only have 1 comorbid (high blood pressure) When i 1st started on this journey, the dr assured me that it wld be no problem for me to get approval with a BMI of 35 and HBP...What am I to do now??? PLEASE SOME HELP ME.....

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GermaineF    25

GermaineF
Posted

Did you also see your PCP once per month or just the dietician? My bariatric center gave me a form that my PCP had to fill out every month. Plus, I had my PCP scan my food log into my medical record every month. I was approved after six months, but I had 3 comorbidities (HBP, cholesterol & sleep apnea) & a so maybe it had nothing to do with the medical record? And I didn't have BCBS but I dunno...I thought I'd throw it out there... just trying to help?

So sorry!

:(

/P2P

Yes, I saw both PCP and dietician, i will wait to see what happens next, drs office will be sending in more info...

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GermaineF    25

GermaineF
Posted

Also, I've spent some time in Lafayette, Louisiana. I dunno how anyone diets there. You guys have the best food in the world!

I agree, we do have the best food in the world.....lol

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MelindaH    3

MelindaH
Posted

Yes, I saw both PCP and dietician, i will wait to see what happens next, drs office will be sending in more info...

With my insurance, BCBS Federal the only way they will pay for bmis betweek 35 and 40 is for defined co-morbities. I think you have to have at least two, but I could be wrong.. I hope that you can get yours turned around on appeal. All the best to you!

Melinda

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amaral1407    11

amaral1407
Posted

Hi

Do you know exactly what the form said that your pcp filled out. I too was denied by Aetna, seeing my pcp, nutrionist, and psych, they are stating pcp did not provide enough info?

Did you also see your PCP once per month or just the dietician? My bariatric center gave me a form that my PCP had to fill out every month. Plus, I had my PCP scan my food log into my medical record every month. I was approved after six months, but I had 3 comorbidities (HBP, cholesterol & sleep apnea) & a so maybe it had nothing to do with the medical record? And I didn't have BCBS but I dunno...I thought I'd throw it out there... just trying to help?

So sorry!

:(

/P2P

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GermaineF    25

GermaineF
Posted

I was approved by BCBS in three diferent ocassion throughout the six month period, to find out the night before my surgery that it had been denied...... I was heart broken, but I went ahead anyway at that point I could eat a cow,lol, I pull out a credit card and had it done, I appealed the surgery a month after I had it done and they approved it and refund my money within 4 months.

Keep going at them dont give up, keep calling and writing to them.....

Laura

WOW..R U SERIOUS?? I'm so glad it worked out for you. Did you have more than 1 comorbiditie, and what was your BMI?

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needanswers    0

needanswers
Posted

Oh noooo.... you sound like me. I have an MBI of 35.44 with HBP and family history of morbid obesity and diabetes. My husband and I have both been approved for the 6 months dietitian (his MBI is much higher then mine). I wondered if it meant we would be approved for the surgery if we got approved for the dietitian. What type of insurance do you have? I have an *** with Anthem Blue Cross of California 10/100.

I'm very upset right now b/c for the past 6 months i've been going to the dr and dietician for 6 months straight, saw a psyc, and did meal replacements only to find out that I was DENIED!!!! Now get this...they said i as denied b/c i didn't have documentation of 6 months non surgical weighloss, (duhhh i saw dietician for 6 months) and also b/c i only have 1 comorbid (high blood pressure) When i 1st started on this journey, the dr assured me that it wld be no problem for me to get approval with a BMI of 35 and HBP...What am I to do now??? PLEASE SOME HELP ME.....

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amaral1407    11

amaral1407
Posted

I have Aetna ***, they have been buying 100% of my nutritionist every two weeks since July. I have been looking at the setback as something positive. I'm getting to learn more and more about eating properly and reading labels. Hoping Aetna will still pay after the surgery so I can continue with the support!!! Good Luck !

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