External Review/appeal

[Heyher 581]

Anyone go through the external appeal process? Just wondering what this may be like. They say no because 5 years of BMI over 40 isn't recorded. We are trying to appeal under medical necessity because of apnea, fibro, and ms. Just wondering if the external board looks at more then just the policy....

[DreamsOfSkinny 53]

Anyone go through the external appeal process? Just wondering what this may be like. They say no because 5 years of BMI over 40 isn't recorded. We are trying to appeal under medical necessity because of apnea' date=' fibro, and ms. Just wondering if the external board looks at more then just the policy....[/quote']

I'm going to have to do a Dr review where my Dr will call the medical director of my insurance within the next week to appeal. I have UHC and the medical director said bc of not having bMI of 40+ for past 5 yrs. although when I call about my benefits (which I've done 3 times) it states either bmi of 40+ OR 35+ w/2 comorbities. I also found that my Drs office didnt submit the highest weights I was for 2 yrs and didnt submit any weight for the 5th yr needed so I'm pretty mad with them and have to get the info corrected tomorrow so at least when the Dr talk to the ins. Director he has the right info. I'm scared though bc for 1 yr I was pregnant... So not sure they'll accept my weight.