HELP! Denied by BCBS IL Boeing ins.

[Skalleywag 12]

Please help, I just got a denial letter from my surgeons office saying that I didn't have 2 comorbids that have not responded to maximum medical management that are generally expected to be reversed or improved by bariatric treatment!!!!

My BMI is 35.6 my comorbids are a high cholesterol of 254 and sleep apnea. I have had high cholesterol for years with no medication and I have had a sleep study done years ago but I dont use a cpap. Any ideas on how to appeal this decision?? My surgeon's office submitted all other requirements. I have tried other weight loss methods like weight watchers, used phen phen, Atkins diet, dexatrim, slim fast, scarsdale medical diet, grapefruit diet, etc..Any info would help... I am desperate !!! I am scheduled for surgery on November 4th supposedly. Very upset and can't stop crying here..

[Mellordi 17]

Call your insurance carrier in the morning. Find out what THEY require in order for them to approve you. Most often, the surgeon and insurance companies want different factors in order to qualify. Some surgeons are ok with no attempts of weight loss, while the insurance company will want documented 3 months of a dietician weight loss approved diet. Once you find out what the insurance company wants, file an appeal and start working on getting their requirements out of the way.

[kvdme 64]

This is why some put on weight to get up to the magic BMI number of 40. No co morbid required. All you can do is appeal with a strongly worded letter from your PCP and surgeon that states neither condition can be addressed or has responded to treatment.

[MNMema 82]

I agree...just eat everything bad and get your BMI up to 40. That truly is a magic number! I know this sounds wierd but it will work! Sorry you are having a tough time though...that would be a terrible letdown.

[LoryLosesXS 154]

Please help, I just got a denial letter from my surgeons office saying that I didn't have 2 comorbids that have not responded to maximum medical management that are generally expected to be reversed or improved by bariatric treatment!!!!

My BMI is 35.6 my comorbids are a high cholesterol of 254 and sleep apnea. I have had high cholesterol for years with no medication and I have had a sleep study done years ago but I dont use a cpap. Any ideas on how to appeal this decision?? My surgeon's office submitted all other requirements. I have tried other weight loss methods like weight watchers, used phen phen, Atkins diet, dexatrim, slim fast, scarsdale medical diet, grapefruit diet, etc..Any info would help... I am desperate !!! I am scheduled for surgery on November 4th supposedly. Very upset and can't stop crying here..

Your insurance should have an appeal process. Call the number on the back of your card. Call your surgeons office and ask them for advisement. I thought most insurances didn't approve unless you are a 40 bmi, but I'm not an expert.

[Skalleywag 12]

Call your insurance carrier in the morning. Find out what THEY require in order for them to approve you. Most often, the surgeon and insurance companies want different factors in order to qualify. Some surgeons are ok with no attempts of weight loss, while the insurance company will want documented 3 months of a dietician weight loss approved diet. Once you find out what the insurance company wants, file an appeal and start working on getting their requirements out of the way.

Ya sorry I did not clarify the denial was from my insurance co BCBS IL and went through coordinator at my surgeons office. I have researced my insurance policy and felt I had everything in order.

[Tiny One 223]

Do you have any other medical conditions that they can list? I was borderline diabetic, borderline for high blood pressure & cholesterol. Doc listed that with my acid reflux, sleep apnea & joint /back pain. Doc also asked me if I tinkled a little when I sneezed, and my answer was, yes. While my BMI was around 35, but doc said she'd list all of these things and was certain I'd get approved with no problem. And was right.

I'd suggest finding out exactly what your insurance carrier requires. And then speak with your doctor regarding any other conditions that you haven't discussed.

Good luck, and don't give up.

[TeresaRN 57]

I would not eat your way to a BMI of 40. Call your insurance. Get a letter from your PCP saying they recommend the surgery. See if you can start meds for your cholesterol and get a cpap. Gaining more weight is not the answer.

[Skalleywag 12]

Do you have any other medical conditions that they can list? I was borderline diabetic, borderline for high blood pressure & cholesterol. Doc listed that with my acid reflux, sleep apnea & joint /back pain. Doc also asked me if I tinkled a little when I sneezed, and my answer was, yes. While my BMI was around 35, but doc said she'd list all of these things and was certain I'd get approved with no problem. And was right.

I'd suggest finding out exactly what your insurance carrier requires. And then speak with your doctor regarding any other conditions that you haven't discussed.

Good luck, and don't give up.

Yes I have other conditions that are not qualifiers but my surgeon assured me he would put in paperwork to insurance co. Like stress incontinence , chronic back and neck pain, acid reflux, plantar fasciaitis etc. My insurance needs 2 comorbids which are diabetes, hypertension, osteoarthritis,sleep apnea, and dyslipidemia. I have sleep apnea and high cholesterol which both apply. So I don't know what else they want. So discouraging.

[LoryLosesXS 154]

Yes I have other conditions that are not qualifiers but my surgeon assured me he would put in paperwork to insurance co. Like stress incontinence , chronic back and neck pain, acid reflux, plantar fasciaitis etc. My insurance needs 2 comorbids which are diabetes, hypertension, osteoarthritis,sleep apnea, and dyslipidemia. I have sleep apnea and high cholesterol which both apply. So I don't know what else they want. So discouraging.

That should do it. I still would call your insurance company and ask what specific things would help them to approve you. Tell them you're suffering. Don't give up! I wouldn't go back to eating your way to 40 bmi as someone recommended. That's a lot of weight to put on. It sounds like you need fresh data for the insurance company. Hang in there.

[NewAshes 232]

Some insurances do not accept high cholesterol.

[Skalleywag 12]

I am writing a letter to submit to my insurance co and will be calling the surgery coordinator first thing in the am to see what she recommends. And then I will be calling the insurance co and bugging them. I am so angry and upset that I have my husband quoting "Rocky" saying it's not how you get knocked down but how hard you fight to get back up or something along those lines I will not be giving up !! I don't feel it's a option for me. Thanks everyone. Please keep the ideas coming anything helps. :wub:

[Mellordi 17]

It may not just be that you need 2 comorbids. Your insurance may want you to go on a medically supervised diet for three to six months. My husband works for FedEx and we have Anthem BCBS and I was 100% certain I was going to have to do a diet for three months but, surprisingly didn't have to. Don't give up! Call everyone you an think of and be firm and let them know you are suffering. Keep us posted. Good luck!

[Skalleywag 12]

It may not just be that you need 2 comorbids. Your insurance may want you to go on a medically supervised diet for three to six months. My husband works for FedEx and we have Anthem BCBS and I was 100% certain I was going to have to do a diet for three months but, surprisingly didn't have to. Don't give up! Call everyone you an think of and be firm and let them know you are suffering. Keep us posted. Good luck!

My insurance used to require a 6 month diet but recently got rid of that requirement in February of this year. So it's just the BMI 35 or higher plus 2 co-morbids or 40 BMI and no co-morbid. And psych eval and nut stuff which I have already completed.

[Bellanthin 112]

Please help' date=' I just got a denial letter from my surgeons office saying that I didn't have 2 comorbids that have not responded to maximum medical management that are generally expected to be reversed or improved by bariatric treatment!!!! My BMI is 35.6 my comorbids are a high cholesterol of 254 and sleep apnea. I have had high cholesterol for years with no medication and I have had a sleep study done years ago but I dont use a cpap. Any ideas on how to appeal this decision?? My surgeon's office submitted all other requirements. I have tried other weight loss methods like weight watchers, used phen phen, Atkins diet, dexatrim, slim fast, scarsdale medical diet, grapefruit diet, etc..Any info would help... I am desperate !!! I am scheduled for surgery on November 4th supposedly. Very upset and can't stop crying here..[/quote']write a letter tell them your going to the insurance commissioner , news, lawyer tell them u feel u r being discriminated against, have surgeon write a letter saying why he feels it's medically nessasary And get copy's of all ur paper work the more papers the better don't give up I didn't n I won