Insurance Got denied with a low BMI-but waiting to resubmit with a higher BMI--HELP!

[Tourist55 43]

Hi everyone,

So I wanted to share my story so I could maybe get some insight from people who have gone through the same thing I am going through. I originally had a BMI of 36.4 and thought that arthritis was one of the co-morbid conditions which Oxford insurance would cover, but it was not, and I got denied. Now, I am allowed to appeal, but my weight has definitely increased, so my BMI is higher. If I was to have a BMI of 40 at this point (which I am very close to), do you think they will cover the surgery now that I am heavier and at 40 BMI? Do I have to appeal with a new weight? Or do I just resubmit all my papers to insurance with the new weight/BMI? Has anyone ever been in this situation before?

Thanks so much,

B

[cindymg 629]

Are you working with an insurance coordinator at your surgeon's office? They should be able to help you.

[kari61 128]

I originally was denied for a low BMI...I Needed 2 co-morbidities that I didn't have. I went for a sleep study test and found out that I had mild sleep apnea, so I went back a year later, my BMI was higher and I had 2 co-morbidities then, one being the sleep apnea and the other was high cholesterol I think..I finally got approved with my new information. So you would probably want to appeal with your new BMI level and see if you have any co-morbidities that will help you to get approved..good luck!

[TwinsMama 483]

You may have to have proof you've been at the higher BMI for a period of time. People gain all the time to get surgery and insurance companies are on to that now.

[Tourist55 43]

Yes, I have a surgical coordinator but I have been workign with my general practitioner also since she wrote my letter of support. She actually is referring me for a sleep study to see if I have any sleep apnea. I only need 1 comorbid condition if i have a bmi between 35-40 with my insurance but i am afraid i dont have sleep apnea. Thanks for all the advice! I'm going to have to see what my surgeon says.....

Thank you!