what i feared the most has happened:(

[determined1 3]

well today I have been told by my insurance co Anthem BCBS that I have been denied b/c sleeve is 'not medically necessary' which is confusing to me b/c I am 100 pounds overweight, BMI 41 and being treated for high blood pressure. When I spoke to BCBS, they told me that my provider should contact them for more information on the 'not medically necessary', that right now there was nothing more that I can/should submit. Ok but I know I've read on here how ppl submit letters of appeal!! I'm so confused, SOO depressed~ I have tried to have positive thoughts all this time just to be let down. Please give me any help you may have, including letters of appeal! I will fight for one more denial/approval but then I will bow out, I wont put myself thru this emotional roller coaster:scared0:. Thank you in advance-

[Chancie 65]

determined1-

All I cn tell you is.......... I was a self pay. My insurance has absouluty NO weight loss in it's covrage. I tried for 3 years.

IF your isurance has hoops you have to jump thru.... DO IT!! Or.. pay like I did ( and it suxs)

Both My pcp and my knee surgene were ready to write letters,, send documents etc........ but it didn't matter. my insurance did NOT cover weight loss.

I know I am probably the "black sheep" but if I could have my insurance pay for RNY I would have had it done............. even tho I wantd the sleeve.

I just KNEW I had to do SOMETHING!!!!

[determined1 3]

OMG!!!!!!!!!!!!!!!! Got a call from Drs office insurance dept. said that I was denied b/c Anthem didnt have my weight & height BUT it was there they just didnt see it, Anthem APPROVED ME!! WHAT A ROLLER COASTER RIDE TODAY! I am one step further to my goal that I am determined to get to....

Chancie! wow! what an inspiration you are! Congrats on your weight loss, I'm happy for you, and like you, I know I have to do something, its just going to get worse if I dont. Thanks for your thoughts.

[pnw218 14]

CONGRATS!! So glad you finally got some good news! It seems so frustrating that businesses can hold us as hostages sometimes, especially when it has to do with our health.

Celebrate and know that you are on your way!

[girldep 0]

Congratulations! What great news! You are now officially on your way! Yay, you!! My insurance will not do wls. Period. I was self pay... But God made it happen for me:). Good luck to you!

Edited March 30, 2010 by girldep

[ouroborous 519]

Count yourself lucky -- my insurance simply will not cover WLS at all. So I'm forced to shell out 20k out of pocket.

But, from what I hear, it's worth it...

[Lookinupin2010 0]

The day you get approved is like the best day ever, isn't it? Congratualations....you are now on your way.:thumbup:

[2muchfluff 1]

Yay!!! Happy ending to a sad beginning!

[MidwestGirl 8]

Woot!!!! :thumbup: Doing cartwheels for ya! Well, spiritual cartwheels! :laugh0: And I was all ready to post to tell you not to give up!!!! Congrats on your approval!

[MlkPas 5]

Fabulous news!! Congratulations!!!

[sleevegenie 0]

i was gonna send you a copy of my appeal letter, i have anthem blue cross and was denied because they say it is experimental, i am so JEALOUS, i wish you all the best and hope for the same for myself, take care

[Linda91 0]

I am just beginning the journey to get Anthem Blue Cross to approve the Sleeve Gastrectomy. Can you give me any suggestions? Did Anthem finally give you approval and they are going to cover your Sleeve? I am so worried, I know they will pay for the By-pass and the Band, I would love to hear that they will also pay for the Sleeve? Help please.

[sleevegenie 0]

I'm gonna fight them all the way on this, if people with kaiser, united and aetna can get the sleeve, they no longer consider it experimental then its not fair that people with other insurance can't get the same chance, hopefully we will win and get our sleeves, best of luck to us both

[determined1 3]

you guys are so great! Thank you!

Jeani & Linda~~ yes they did finally approve me and I will help you in any way I can.

Why did they deny you? Anthem denied me stating that it was "medically unnecessary" but I when I questioned it (my bmi over 40 & high blood pressure)Anthem said that they actually denied me because they didnt see my height & weight in the submission!!? When I called Drs office, they called Anthem and told them where to look on the paperwork & that it was in there all along so my paperwork went back in front of the review and was approved!! OMG talk about doing their job for them! Furthermore, Drs office said that this wasnt the first time Anthem denied and a call or appeal changed their minds!! SO FIGHT GIRLS! I'M ON YOUR SIDE, EMAIL ME IF I CAN HELP YOU.

[sleevegenie 0]

i was denied becasue Anthem blue cross of California still consider the sleeve investigational? so i am going to appeal with them, and if they deny my appeal i am going to take it to the State's insurance commisioner, so wish me luck and with God's help i will get my sleeve, please keep my updated with your progress, i'm so happy for you , but i'm a little green with envy over here, i want one too!!! )