Bcbs: Denied 1St Time; What To Do For Next Attempt?

[JSahi 6]

I was denied earlier this year by bcbsil. I can not remember the exact reason but I believe it was because I had no major health issues, besides my weight. But I have had some bothering issues since then and also want to try again. I was wondering if anyone went through this (being denied) and got approved the 2nd or 3rd time around, if so what did you do? I havent applied/signed up yet. Attending seminar on the 24th.

(bcbs members would be awesome to reply back but anyone else is more than welcomed if had similar problem)

[Mayasgram 351]

BCBS of Michigan makes you jump through hoooooooops. One year diet monthly Dr visits , I had Hypertension, Asthma Reflux besides my weight and they were fine go through a year, of which my Dr said do not lose any weight or they will deny you, After a year they made me wait 90 days more to approve the surgery.I might add all my pre band problems are gone now as well as the weight.

But I was told 4 years ago that BCBS Florida won't approve Lap band so Good Luck, I don't mean to discourage you so talk to your Dr and see what help they can give you they work with these jerks everyday and they may have some ideas that work with insurance it can just be a different phrase that gets you approved. Doesn't it just suck that you get to pay for insurance and they get to tell you what you need and not your Dr.

[mommykristie 59]

I was denied from bcbs of AL and even denied all of my appeals. I did not have any of the comorbidities that they accept ( medicated hypertension, medicated diabetes or treated sleep apnea) and during the three years of weight documentation, the first year I was slightly below the morbidly obese range. In order for the surgery, the ins will only pay for morbidly obese unless you have one of the three medical conditions. So, I had to wait and complete another 6 months of supervised diet, etc and wait until January of 2012 so that it would be a new year on record which dropped off my first year's records. During that time, I had to maintain withing a very narrow range to keep from being denied. Luckily, my primary dr was great about working with me on making sure I stayed within the range. For example, I had gotten a terrible virus and lost weight which put me below the morbid range by two pounds. So, we waited a week, let me recover and of course those two pounds came back on, which was the weight recorded on my WLS form. After all of those hoops, it took just a couple of days to get approved. Good luck to you and don't give up!!

[JSahi 6]

Thank you ladies! Very helpful.

[deckerr888 4]

I had a similiar experiance as mommykristie. I was denied the first time because I didn't meet the morbid obese range in the last three years before my surgery. I had to wait six months until the next January to be able to start the process again. This time with I was able to meet the three years and bcbs approved my surgery within a few weeks. I did, however, have another preexisting condition I was being treated for (PCOS) and I got a letter of recommendation from my doctor who was treating it which went with my file to the insurance company to help strengthen my case. I started the process again on Jan 4 and my surgery was Feb 20.

[Jewett Hopeful 1]

I was denied earlier this year by bcbsil. I can not remember the exact reason but I believe it was because I had no major health issues' date=' besides my weight. But I have had some bothering issues since then and also want to try again. I was wondering if anyone went through this (being denied) and got approved the 2nd or 3rd time around, if so what did you do? I havent applied/signed up yet. Attending seminar on the 24th.

(bcbs members would be awesome to reply back but anyone else is more than welcomed if had similar problem)[/quote']

I was wondering if you ever got approved about to apply thru BCBS Tx.

[ChefMelissa 0]

I was approved thur bcbs al the first at the age of 19 due to have two medical conditions

[taraepperson 18]

I have bcbsil. You are automatically approved with a bmi of over 40. However , if its 35 you need 2 health conditions. I had a 37 bmi, but high blood pressure and cholesterol. I was approved in 2 days. Bcbsil has also dropped the waiting period. Once approved, you start your 2 week diet and get it done! So glad I did it. AND my cholesterol and bp are both down. I was 215 a d now 170! Love it!

[MsRhonda 123]

I have bcbsil but i had bmi of 40 with asthma and gerd i was approved in a week it wont hurt to try again

IM MY OWN MOTIVATION

[PJ Geeser 108]

Outside of being overweight...I had no other health conditions. I did have to do the 6 months of supervised visits first...dr then submitted and was approved in about 1 1/2 weeks. Just call and ask them directly about the requirements...everyone is different and you really want to know what you are dealing with and what your policy covers.

I only had a choice of 2 places they covered..which were each 2 to 3 hours away...so check to make sure your hospital is covered as well. Good Luck to you

[dream_small2013 19]

I have bcbsil. You are automatically approved with a bmi of over 40. However ' date=' if its 35 you need 2 health conditions. I had a 37 bmi, but high blood pressure and cholesterol. I was approved in 2 days. Bcbsil has also dropped the waiting period. Once approved, you start your 2 week diet and get it done! So glad I did it. AND my cholesterol and bp are both down. I was 215 a d now 170! Love it![/quote']

Heyy I was reading this and wanted to know where does it say you can get approved like that. My BMI is 44 sadly and I am going for my first doctor apt ever for trying to get approved. I also have PCOS, with high Testosterone lvls border line diabetic, and horrible back problems. I'm only 21 I'm 5'5" an weight 263.5lbs I'm so nervous about my apt I want things to go smoothly but feel like I will he denied. So if you have links you can send my way with it stating if your BMI is over 40 you'll be approved please send them thank you

[nachae2005 21]

BCBS of Illinois has "hernia band" coverage, which is how I got my band. My BMI is over 35 but I have no comorbidities. I went to True Results, and (after an EGD to document GERD and a hiatal hernia) ins covered a large portion of my WLS and aftercare.

I can't say enough good about true results. From my consultation to surgery date was 1 month. I def have a bit out of pocket to cover, but this way my ins will cover after care (as opposed to me paying for it outright, then I couldn't file claims for follow up and fills). And True Results was on my side and totally supportive and straightforward from day one.

[nachae2005 21]

Hernia band sounds confusing..... its actually "hernia repair via Lap Band"