So I Got Denied Today

[DreamsOfSkinny 53]

Ins. Director said my BMI had to be over 40 for last 5 yrs. This aggravates me as my benefits state 35+ w/2 comorbities OR 40+. I also am annoyed bc my Dr. Office submitted the wrong weights for each year! Now the dr. Office has to wait to get the denial letter and schedule a peer to ppeer reviews to have the Dr. Talk to the medical Dir. That made the decision

[DreamsOfSkinny 53]

I have to now call my Dr office tomorrow to make sure they get all the highest weight I was for each year right! Bc I know I should be 35+ and have 2 issues. Asthma and high cholesterol.

[rainbows 35]

im sorry! i hope that they fix the numbers so you can be approved!

[DreamsOfSkinny 53]

im sorry! i hope that they fix the numbers so you can be approved!

I hope so too and that my surgeon can make whatever case he needs to for that phone call.

[ReduceReuseRecycle-Me! 119]

I believe the comorbidities have to be directly weight-related.

[Livinglifeout 217]

Keeping my fingers crossed for you.

[armygirl 19]

Good luck, I know how hard it is to get approved!

[Heyher 581]

I have same requirements. I have been at or above 35 for 7 years. I have sleep apnea. I also have MS, fibromyalgea, had reconstructive knee surgery, arthritis.

I did peer to peer for the first level of appeal, and told no. Sent in written appeal for medical necessity. Told no. Sent final appeal for external review. If that is a no, last option will be to beg my employer for an exception.

My fingers are crossed the peer to peer gets you approval.

[DreamsOfSkinny 53]

I believe the comorbidities have to be directly weight-related.

I were told these were as well as another issue I was dx'ed with---intercranial hypertension

[DreamsOfSkinny 53]

I have same requirements. I have been at or above 35 for 7 years. I have sleep apnea. I also have MS' date=' fibromyalgea, had reconstructive knee surgery, arthritis.

I did peer to peer for the first level of appeal, and told no. Sent in written appeal for medical necessity. Told no. Sent final appeal for external review. If that is a no, last option will be to beg my employer for an exception.

My fingers are crossed the peer to peer gets you approval.[/quote']

Oh WOW! Well mine says 35 + 2 comorbities... So you could qualify it sounds like. I have carpel tunnel and arthritis in knee which both are weight related.

[Heyher 581]

Did you talk to the doctor? Fingers are crossed for you.

[coolmamma73 129]

Co morbities that the insurance considers such are severe sleep apnea, hypertension, heart disease and diabetes. Most don't consider high cholesterol or joint pain morbities.

They are very specific on what they consider these to be. Maybe that's why u were denied?

Hope u get it resolved, it's so frustrating I know!!

[cbd 78]

I'm right there with you. Been working on this since May, submitted in Oct and one week later was denied. They said I didn't have enought documentation supporting my two co morbiditys. I have high bp and have been on medication for 13 years and have high cholesterol and have been unable tobring it down with diet and fish oil. I returned to my GP last week, had additional labs done. My cholesterol has gone up another 25 points..started on medication for that. She resubmitted labs and treatments. I called insurance today and they said they denied it again cause we didn't submit anything new. I asked them about the office visit not and labs from last week and she looked and acted like it was the first time she saw that. She sent the new info to the medical reveiwer and will call me when she hears an answer. I am sooo dissappointed and am not expecting to hear a good outcome.

[MrsBenson 29]

Don't feel bad. I got mine approved with no Co morbids. And my insurance says u need 2. Also. I started Dec last year and have been denied 3 times and finally got approved last week. Just keep doing what they ask.

[DreamsOfSkinny 53]

So I called again and got ref. number for call stating that I only need 1 co-morbidity and bmi of 35+ for past 5 yrs although the medical Dir. Of Ins. Said I was denied bc I didnt have bmi of 40+. Second issue the insurance chose 2 of my lowest weights for 2 yrs and didnt even mark down for a whole year EVEN THOUGH my dr. Submitted all health documents! I talked to my ins. Coordinator at Dr office today