Denied

[aldmb2 24]

Well, my 23 page appeal letter was denied by my insurance. Any suggestions for the external appeal process?

[tasherie 35]

Why were you denied??

[Was a humpty dumpty 35]

Appeal to your State Insurance Dept.

https://www.insurance.state.pa.us/dsf/complaintform.html

[aldmb2 24]

My BMI is lower than 50. That is my insurers policy. From what I've read online even the external appeal cannot over-ride a policy.

[vivienvixon 1]

What insurance company do u have?

[aldmb2 24]

Highmark BCBS

[lisahg 9]

Hey

I have Highmark bcbs and was denied for the same bmi reason. An independent Review Organization (IRO) who handle external appeals do have the authority to overturn denials if they deem appropriate. That is what happened in my case, so there is still hope..

[aldmb2 24]

Did you send them the same letter you sent for the initial appeal to your insurance?? Ive read your letter & its wonderful. Did you add more?

[lisahg 9]

I had forgotten I had posted one of my appeal letters. I believe it is what I sent for the external appeal. I also sent copies of all of the journal articles and position papers (with relevant text highlighted) I had referenced. Good Luck! I will keep my fingers crossed for you.

[Benjamin Prez 4]

BMI means what?

[aldmb2 24]

BMI means what?

Body Mass Index

[vsggal 1]

My BMI is lower than 50. That is my insurers policy. From what I've read online even the external appeal cannot over-ride a policy. <img src='http://www.bariatricpal.com/public/style_emoticons/<#EMO_DIR#>/sad.png' class='bbc_emoticon' alt='' />

Oh wow! What is your current BMI??? Did you do the 6 month classes at your surgeon's office??? I have a BMI of 42 and my first class is this month...it's $60 a session for 6 months...I hope I'm not wasting my time and money!!!!! I already went to the seminar and met with the Dr & insurance coordinator and they said I qualified...then I hear story's like yours and I start thinking I'm going to have a heartbreak!!!

[aldmb2 24]

My current BMI is 44. I was initially doing the band & mid way through the 6 months I changed my mind to the sleeve. My Dr. office dropped the ball & never checked to see if I was approved. It was definitely heartbreaking. Now, Im looking into self pay, and found out that if my insurance company's external review approves it after I will get reimbursed. So its one positive.

[Texas89 8]

Hi have you been approved yet?! I have highmark bcbs and it took 2days to approve me for the sleeve, if you wanna know how i got approved with a bmi less then 50 then message me..