blue cross blue shield comorbidities

[ms.junebug 1]

hi everyone, waiting on my approval or denial from my insurance company, wondering if you guys have experience with blue cross blue sheild comorbidities. i have osteoarthritis, kidney disorder, acid reflex, difficulty breathing, hs (skin condition). family history of diabetes and heart conditions and obesity. Also have proof of 5 yrs of being obese. i clocked in at a bmi of 37. gave all my paper work, nutrition classes, group meetings, medical necessity letter and phyc eval. what do you guys think? approved or denied????

[Rena's got this 274]

It sounds like you have a good chance of initially being denied. Just appeal, and keep appealing until you get to the Peer to Peer review.

I have BCBS of Alabama and am just getting started. I have a BMI of 40.9, (surgeon's office), but haven't been this high for the past 3 years. The only co-morbidities I have are pre-diabetes, high cholesterol, and joint pain. I'm going for a sleep apnea test this week. My insurance seems to only require one, so I might have a chance. The surgeon's office said that BCBS of Alabama is very nitpicky though, so I'll probably get denied initially.

Let us know what happens.

[2nd Time Karen 8]

I bet they approve you Rena.

[Rena's got this 274]

I bet they approve you Rena.

I just looked back in my medical records and found that I was diagnosed with GERD in 2011. Still have it, lol. I think that was one of the co-morbidities listed on my insurance information sheet, so, keeping my fingers crossed and am going to go ahead with the 6 month weight loss management thingy.

[Rena's got this 274]

Ms.Junebug have you heard anything yet??? I'm sooo keeping my fingers crossed for you!

[Janett 87]

I got denied I am waiting to hear back re: the appeal ... According to bcbs I haven't had a co-morbid condition for the past 5 yrs (which I have) lets see what happens

[Rena's got this 274]

From what I understand, a first time denial is almost standard practice with BCBS. Keep on with the appeals and good luck!

[JulyFireFly 6]

I have BCBS FEP. BMI was 57, 3 month supervised diet with NUT and PCP, psych eval, sleep study = sleep apnea. Had 5 yr weight history. My approval came one day after submitting my paperwork. I was told by my surgeon that my approval came so quickly due to my PCP writing a 3 pg letter supporting my choice to have VSG. He says it played a huge role in the approval process

Hope this helps!

[Rena's got this 274]

Well...I can add one more co-morbidity to my list. I have moderate to severe sleep apnea. I'm not sure if it will count though, since it hasn't been documented for the past 3 years. Anyway, I slept last night with a cpap machine for the first time ever, and I can't remember the last time i slept so deeply.

Maybe I'll eventually catch up on all my disturbed sleep and can actually have some energy during the day.

So.... 40.9 BMI, GERD, Sleep apnea, pre-diabetic, knee and hip problems. Maybe I've got a chance with the insurance peeps. Now I've got to get my PCP on board and knock out this 6 month diet.

[Nesa 51]

I have bsbc Michigan. I was approved I had to see a nut, shrink, and a endoscopy everything was fine then they told me my insurance requires to take 5 weight management classes =\. Once I'm done with that they will send it to my insurance and we will set a date. I'm afraid it will be denied or something.

[Rena's got this 274]

Well, if you are denied, just appeal, and keep appealing. Get your doc involved too, which seems to help in the appeal. I haven't submitted to my insurance yet, but I'm prepared to go through as many appeals as it takes if I'm denied.