Denied For The Second Time!

[NCHope 0]

I was denied when my doc. sent in my stuff to ins. (bcbs) I have bmi of 38.5 and moderate sleep apena. My policy on wls says severe sleep apena. I told my case manager and the Dr. this but they said don't worry about it. BCBS is easy and we can get you approved. So I got my hopes up big time!

I am $500 approx. out of pocket for all these tests that I would have never had done. I know my doc. office can't garuntee me anything but they do this all the time and I got fooled!

My doctor did the peer to peer today and was still denied.

What should I do now? I am so upset and discouraged. How much is Mexico? Does it include airfare?

thanks

[shellbell33081 115]

I went to Dr. Garcia in Mexico. I spent $5000 through Successfully Slimmer. My airfare was not included so I paid $350 for my ticket. I had a great experience!! If you decide on Mexico, do a lot of research and be comfortable with who you choose. A cheaper price isn't always the better choice. Good luck!

[futureskinnypants 193]

Did you do the written appeal? I've seen some people have to write a letter to their insurance company and state all the points in which you SHOULD be approved for the surgery. I'm sure its some where in the forums.

Also, maybe you can ask your doctor and see what he says?

I have BCBS and i was all set up to have my first appt and orientation with my surgeon and then i decided let me call and just ask what criteria i have to hit with BCBS . I did, and their response was " We don't cover bariatric surgery" i left it at that and then called back a few days later and they gave me the same response. I asked if i could change my policy to one that did cover it and she told me no , we don't cover it. So i dont know what the deal was. at that point i started looking for other surgeons.

Good luck to ya!

[JourneyOfAFatKid 6]

I feel your pain. I have BCBS and got denied 3 times and then had to wait 6 months before I got to submit again. It was because I was THREE POUNDS too light. And then they told me that if I gained weight to qualify, they would deny me again. But I did it anyway and submitted to them 6 months later (to the day) and they approved me in less thn two weeks. I'm not telling you to gain a bunch of weight because I don't know how much you would need to gain to qualify but... I'm just sayin.. it worked for me. AND I wrote a huge essay on the cost of weight related medical cost and how much more they would end up spendng on me if they didn't just let me get the surgery. I also included pics of myself in a bikini. (yikes, lmao) just for effect.

[Toni Day 18]

My BMI was under 40 and I had mild sleep apnea. My doctor was honest said insurance would never approve it. I waited 8 months gained the weight I needed to be at 40 and just had my surgery 2 weeks ago. Good luck.

[littlebits 154]

I was denied when my doc. sent in my stuff to ins. (bcbs) I have bmi of 38.5 and moderate sleep apena. My policy on wls says severe sleep apena. I told my case manager and the Dr. this but they said don't worry about it. BCBS is easy and we can get you approved. So I got my hopes up big time!

I am 500 approx. out of pocket for all these tests that I would have never had done. I know my doc. office can't garuntee me anything but they do this all the time and I got fooled!

My doctor did the peer to peer today and was still denied.

What should I do now? I am so upset and discouraged. How much is Mexico? Does it include airfare?

thanks

I have BCBS of DE. They want individuals to have a BMI of 50 or higher for the sleeve. I had to involve the insurance commissioner. In less than 24 hours, I had an approval. My BMI was 38. I had my procedure done a week ago today.

I wish you the best of luck!!!

Sent from my PG86100 using VST

[IMSKINNY 160]

I have BCBS of DE. They want individuals to have a BMI of 50 or higher for the sleeve. I had to involve the insurance commissioner. In less than 24 hours' date=' I had an approval. My BMI was 38. I had my procedure done a week ago today.

I wish you the best of luck!!!

Sent from my PG86100 using VST[/quote']

What was your argument to the insurance commissioner?

[littlebits 154]

I explained that the bypass doesn't even require a bmi that high. I also included information about how a bmi of 50 or greater was required when the sleeve was a two part procedure & now it is a stand alone procedure...that was my biggest argument. Now, in my case, I qualified for the band & bypass. So, I'm not sure if that applies to you...good luck!

Sent from my PG86100 using VST