Denied!

[RobinGirl 34]

I called my insurance company this morning to check on my case and they told me I was denied. The reason - a BMI of 39.6 with no comorbidities. I am really confused as to why my BMI was listed at 39.6 as the doctor said I had a 41 BMI. Even with that, I still can't believe they denied me because of 4 pounds! Ridiculous!

I am waiting for a call back from my doctor's office to discuss this. I am pretty sure they are going to act all confused as they always are. The front office is so incompetent! I am thinking of going the cash route but with a different doctor. This doctor doesn't deserve my money after working with them for 6 months and having nothing but issues with the front office.

Also - Can I appeal? Can my doctor resubmit with my BMI at 41? Is there a "typo" clause in the appeal process?

[Cazzy 725]

My understanding is that every decision is appealable and more than once too, next time u weigh in, wear heavy clothes like jeans trainers etc money in pockets anything to add a couple of lbs extra that will help too Did the drs office list u 39.6 or did the insurance work out your bmi from their info, i have seen bmi tables saying something different depending on where they were downloaded from so might be worth asking about it. Make sure u get your insurance companies exact criteria for bariatric surgery then base an appeal on that .. good luck !

[TracyC 32]

If you don't get the answers you need from your doctors office, you might want to contact these people: Lindstrom obesity Advocacy and the email address is walter@obesitylaw.com. My doctors office uses them to fight insurance appeals. Not sure how it would work from an individual standpoint but I did nothing other than sign an authorization form. The doctors office forwarded my medical records to them and they dealt with the insurance company directly. I had a response from them within two weeks. And whenever I had questions, they were quick to respond via email.

Good luck with whatever you decide.

[Greekie17 22]

Also, say you are 1/2 to one inch shorter, then the BMI will be higher. Wear shoes and heavy clothes and jewelry at the next weigh in, also water-load! 1 gal. Water weighs 9 lbs- I have watched enough seasons of the Biggest Loser on TV to know this, lol! I hope you get approved. I started with a BMI of around 41.75 but with 2 or 3 co-morbidities it was approved on the first try. Good luck!

[superluli 17]

I could probably gain 4 pounds in 2 weeks I have a guy at work confessed to me he gained 20 pounds to qualify for a gastric bypass... It's only 4 pounds. A hefty meal right before and jeans and wool clothing oughta do it...

[RobinGirl 34]

I spoke with my doctor's office this afternoon and they said that most likely my insurance company used a different BMI calculator to calculate my BMI. I am really frustrated because according to my calculations I do have a BMI of 40. I know that I am right on the edge, but seriously to deny me for 4 pounds is ridiculous! My doctor's office said that my only option is to appeal with a letter about how unhealthy I am. They can't resubmit or adjust the numbers, I can only appeal. I am not sure how this will work as they denied me because of 4 pounds and if I don't meet the requirement, I don't meet the requirement. My other concern is why didn't my doctor consider that they may use a different calculator? They submit to Anthem on a daily basis and they should know the ins and outs. Argh!!!

I am seriously considering going to Mexico as an option. I spoke with Dr Ortiz's office today and I can be in surgery in just two weeks! All for less than my deductible/ copay and my doctors stupid $3000 program fee. I should have just gone to mexico in the first place.

Sorry for the rant but this is 6 months of frustration.

[twi 40]

Sounds like you may want appeal with a different dr. I wouldn't trust a dr that didn't have a good team with him. A dr that expects his team to perform well is someone will perform well

[sharonk 23]

I say appeal it but get a copy of all the paperwork your dr. submitted to insurance. I have been denied three times now and still appealing. the first mistake i made was not getting my very own copy of what was submitted. I just kept assuming the staff at the dr. office was sending the right info. I just recently (last week) sent in my own appeal and awaiting their decision. I think the more info you know and have in front of you, the better off you will be. Good luck!!

[sharonk 23]

I say appeal it but get a copy of all the paperwork your dr. submitted to insurance. I have been denied three times now and still appealing. the first mistake i made was not getting my very own copy of what was submitted. I just kept assuming the staff at the dr. office was sending the right info. I just recently (last week) sent in my own appeal and awaiting their decision. I think the more info you know and have in front of you, the better off you will be. Good luck!!

I say appeal it but get a copy of all the paperwork your dr. submitted to insurance. I have been denied three times now and still appealing. the first mistake i made was not getting my very own copy of what was submitted. I just kept assuming the staff at the dr. office was sending the right info. I just recently (last week) sent in my own appeal and awaiting their decision. I think the more info you know and have in front of you, the better off you will be. Good luck!!

Oops...posted too many time :/

[sharonk 23]

Oops, posted to many times. :/