Insurance denial? Appeal?

[kittydream 2]

I have read that some people get denied and have to go appeal with insurance... What makes insurance deny someone? It sounding like some insurances are being very nit picky...

[SugarFreeMe 293]

Each insurance company has their own prerequisites that their insured have to meet. It's typically a BMI of 35 and higher with 2 or more co-morbitities (high cholesterol, high blood pressure, diabetes, ect...) or a BMI of 40 or higher. Also, some require a 3 or 6 month recorded diet recorded by your PCP or a dietitian before they will sign off. They're all different and deny/approve based on your ability to meet their requirements. It's best to always check with your insurance coordinator before you start your journey.

[Amyllf2 206]

First step is to see if your insurance covers it at all. I had insurance for many years through United Airlines that specifically excluded it from the policy. Also check on state requirements. I live in Maryland so my Carefirst BCBS uses the state guidelines which is pretty much what SugarFreeMe listed above. I had a 6 month supervised diet (or two nonconcurrent 3 month diet) requirement within the last 2 years and a psychological exam.

[terry1118 1,274]

Each insurance company has their own prerequisites that their insured have to meet. It's typically a BMI of 35 and higher with 2 or more co-morbitities (high cholesterol, high blood pressure, diabetes, ect...) or a BMI of 40 or higher. Also, some require a 3 or 6 month recorded diet recorded by your PCP or a dietitian before they will sign off. They're all different and deny/approve based on your ability to meet their requirements. It's best to always check with your insurance coordinator before you start your journey.

Mine also required documented weight loss w/failure to keep the weight off.