Denied...Need some help

[GirlOnFire 111]

I got a phone call from my surgeon's office today telling me that my insurance has denied my claim. My BMI is 36 point something and I only have one comorbity. I have to have two since my BMI is below 40.

I am considering having a sleep study done to check for sleep apnea but to be honest I am feeling so deflated and just down.

If I do the test and find out I don't have apnea...am I dead in the Water? Is there anything else I can do to appeal?

Also...for those that did sleep studies...what was it like, how much did it cost, and did insurance cover any?

:( :(

[MrsPierre 67]

I got a phone call from my surgeon's office today telling me that my insurance has denied my claim. My BMI is 36 point something and I only have one comorbity. I have to have two since my BMI is below 40.

I am considering having a sleep study done to check for sleep apnea but to be honest I am feeling so deflated and just down.

If I do the test and find out I don't have apnea...am I dead in the Water? Is there anything else I can do to appeal?

Also...for those that did sleep studies...what was it like' date=' how much did it cost, and did insurance cover any?

:( :([/quote']

My BMI was 34 w one comorbidity. I did have a lapband but had it removed. My Doc's office didn't think I'd be approved. I think you should appeal the denial after your sleep study. Also, do your knees or back hurt? Have you been depressed? These things can help your appeal. Good luck and don't give up.

[GirlOnFire 111]

Depression: Check

When I attempt to work out I can't do a lot of things because it bothers my knees (running, lunges, etc)

Also....I might have a hormonal imbalance. I don't know if that counts for anything with the insurance though.

[MrsPierre 67]

Then I'd call and tell your Surgeons office that you want to do an appeal.

[lynndtt 21]

This really scares me. I have a BMI of 36 with high blood pressure but my insurance also requires two comorbidities with a bmi under 40. I am going to my sleep study tonight, in about 2 hours. If I have sleep apnea i'm covered, if not I don't know what I'll do. I do snore but who knows. I have bcbs of Illinois PPO. I don't even know if they cover this or not but because I need to qualify I would pay myself just to know. I had blood work done and would also qualify if I had high cholesterol or diabetes but don't know the results yet and doubt that I do. I have to wait two weeks for the follow up appointment on the sleep study. Maybe I can get them to fax my surgeon so I can know before. I'm so ready to get going but so scared to be denied.

[NewAshes 232]

I snore and used to twitch but unfortunately I was negative for sleep apnea but it turns out I only need type two diabetes to qualify which I have. It's a slim chance to get your insurance too approve you if you are under 40 without 2 comorbilitys. What falls under comorbilitys is really different for every insurance. So you should look into your insurance or ask your coordinator what your insurance accepts as a comorbility if you don't have sleep apnea.

[GirlOnFire 111]

This really scares me. I have a BMI of 36 with high blood pressure but my insurance also requires two comorbidities with a bmi under 40. I am going to my sleep study tonight, in about 2 hours. If I have sleep apnea i'm covered, if not I don't know what I'll do. I do snore but who knows. I have bcbs of Illinois PPO. I don't even know if they cover this or not but because I need to qualify I would pay myself just to know. I had blood work done and would also qualify if I had high cholesterol or diabetes but don't know the results yet and doubt that I do. I have to wait two weeks for the follow up appointment on the sleep study. Maybe I can get them to fax my surgeon so I can know before. I'm so ready to get going but so scared to be denied.

I did a three hour glucose test to find out that I am insulin resistant. Perhaps that is something you can look into?

[GirlOnFire 111]

I am going to talk to the woman at the office that handles insurance claims tomorrow and get more information. I will set up a sleep study appt I guess....though Im really nervous about what that will be like....I have a hard time sleeping in my own bed...I can't imagine trying to do it with crap strapped all over my face or whatever it is they do.

[GirlOnFire 111]

I snore and used to twitch but unfortunately I was negative for sleep apnea but it turns out I only need type two diabetes to qualify which I have. It's a slim chance to get your insurance too approve you if you are under 40 without 2 comorbilitys. What falls under comorbilitys is really different for every insurance. So you should look into your insurance or ask your coordinator what your insurance accepts as a comorbility if you don't have sleep apnea.

I have been told by my husband that I snore sometimes and twitch as well in my sleep (a fact I denied until I actually started waking myself up with my snoring) but I don't know if I have apnea...I guess it's a possibility since sometimes people have it and don't realize.

[NewAshes 232]

I have been told by my husband that I snore sometimes and twitch as well in my sleep (a fact I denied until I actually started waking myself up with my snoring) but I don't know if I have apnea...I guess it's a possibility since sometimes people have it and don't realize.

the doctors reasons for my twitching was I was falling asleep and it was my brain waking me up that it wasn't due to not being able to breath. My mom was pretty convinced I had it but I guess not. My aunt has it bad though. You can visibly see her stop breathing and then hear her snore anywhere in the house with the tv on lol

[Pamby 3]

I got a phone call from my surgeon's office today telling me that my insurance has denied my claim. My BMI is 36 point something and I only have one comorbity. I have to have two since my BMI is below 40.

I am considering having a sleep study done to check for sleep apnea but to be honest I am feeling so deflated and just down.

If I do the test and find out I don't have apnea...am I dead in the Water? Is there anything else I can do to appeal?

Also...for those that did sleep studies...what was it like' date=' how much did it cost, and did insurance cover any?

:( :([/quote']

My friend works for an insurance company. She was denied 7 times. Finally her boss said since she was a dedicated employee for so many years, she was approved. Keep appealing...don't give up. She was also well over 40% BMI. Her decision was from DX of diabetes and I believe high BP. Also a family history of heart disease.

I am DX with morbid obesity, reflux, and high BP. (for insurance purposes) Other co-mobidities I have but were not listed for insurance are Bipolar 1 (major depression), anxiety, and occassional urinary incontinence.

Keep at it. There are many co-morbidities, but not sure what your insurance requires or state as well.

I have had two sleep studies done. Didn't bother me a bit. Hooked up to monitors with sticky leads all over scalp and a few other places on body. Then you sleep with a machine that has a mask over your nose/mouth. My other one had the mask on for a short time and the rest of the sleep was without it.

[GirlOnFire 111]

Thanks for the feed back....I am going to pick up the fight again on Monday. Not giving up yet!