Call & fight w/ BCBS URGENT- XP

[honeyrubybee 1]

I've been denied twice for VSG by BCBS. Both times they are saying I didn't have the minimun BMI 40. At my initial consult with my surgeon my BMI was 40.5. BCBS required I follow a 3 month medically supervised diet. In which time, I lost some weigh. Now they're saying I don't qualify!! I'm going to call BCBS & discuss this with them. I've never spoke with rthem before. Anyone have tips, suggests, experiance?? Thanks fo much!

[MINI-Me 196]

It really depends on their policy ... If you need a 40 BMI after the 3 months, then that's the policy ... If it's before, make sure they realize what your BMI was before the 3 months - maybe there was a mix-up in the notes or who read them.

Do they allow 35 BMI with co-morbidities? If so, do you have any?

[KabinKitty 11]

I have BC/BS PPO. I was denied because of the experimental/investigational excuse. They now cover the sleeve in Ohio. I had a BMI of around 35, but have sleep apnea and hbp. I asked the surgeon if I lost weight during the 3 month's supervised diet would that disqualify me. He said "no", the only weight we provide them is your starting weight.

If I were you I would try to get your surgeon's office involved in fighting with BC/BS. I really doubt you will get anywhere by yourself. I agree with Mini Me that it sounds like some figures got messed up somewhere if you started at 40.5.

I wish you the very best!

[StacyS 20]

I just went for my first of the 3 months with dietitian and they told me NOT to lose weight since I'm right at 40 and in order to qualify you have to have a BMI of 40 or higher. I know it sounds backwards but that's their policy...i have BCBS Fed

[StacyS 20]

I would call your patient advocate at doctors and have them give them some push back!! They trend to approve after someone tests their policies!!!

[chicagoanthony 1]

My BMI was 75 with the following comfortabilities.

Pre-Diabetes

Hypertension

sleep Apnea

Venous Deficiency (causing swelling in my lower quadrant of my legs)

i have BCBSIL PPO through my job so..they cant drop me. It took them 4 business days to give me the approval.

If they keep giving you issues, dont forget the law is on your side. Consider a lawyer. Just a suggestion.

[StacyS 20]

Hi HoneyRubybee,

I was just curious to see if you ended up contacting BCBS and what was the outcome?

Stacy