DENIED! : ( BY BCBS FED

[peteyrulz 82]

I'm so upset! My BMI is 38.86 & BCBS Fed (standard) did not approve me because my co-morbidities are not "major". WTH! I have GERD & major depression & MILD sleep apnea, & joint pain but I guess I need to have DIABETES, HTN, and/or SEVERE apnea.

Ugh. I've crying all morning so now I'm ready to get down to business.

Let me also mention that my surgeon's office was not at all helpful. I said, "so do I need to gain X amount of weight to get approved " All she said was "couldn't hurt to try but I didn't tell you that".

Should I pursue this, or should I just start all over again with another surgeon?

I'm spittin' nails!

Has anyone ever gotten approved on the 2nd try?

[Ginger Snaps 1,323]

You can definitely appeal. I read an article that said that 80% of appeals usually get approved. You might have to have your primary doctor write a letter as to how much the joint pain limits your movement or how the reflux makes it difficult to sleep, etc. Your surgeon's office should be able to help with an appeal... you may have to directly ask them to help you with the appeal, though. They should be very experienced working with insurance appeals.

Don't give up with the current doctor yet -- give an appeal a chance. You just need to get some support with that. I've heard some insurance companies have patient advocates that will work with you on stuff like this. I have Anthem BCBS and they assigned me an advocate that calls me every now and then to see how I'm doing. Maybe call member services on the back of the card and ask them what to do to file an appeal. They'll probably be very helpful.

[betty_s 476]

I will say, I HATE the office staff at Carmodys office. He, Maya Paige, and Jeneane (my NP) are all great, but the PSRs and Ellen are the worst.

Sorry you were denied. I would try appealing.

[peteyrulz 82]

Thank you Ginger Snaps and Betty! I called BCBS back and they say that I can not appeal. I am very confused. I'm going to inquire with Lindstrom Obesity Advocacy. The worst they say is no, right? Betty... you are so right about Ellen. She was not in the LEAST bit helpful. I am also inquiring to Bluepoint & tell that them my situation, & it's closer to my home than St. Mary's.

Thanks again!

[Chele H 427]

My insurance company is Aetna and they require the BMI of 40 for at least 2 years....so if you decide to try to gain the weight to push up your BMI make sure it will be enough to get approved. If they do not require a history of a high BMI I would definitely consider gaining a few pounds. I never heard of not being able to appeal. Doesn't sound like your surgeon's insurance coodinator is very helpful and that is discouraging to hear. I wish you the best.

[AngryViking 217]

I find it hard to believe that you can't appeal. What does your denial letter say?

[Kindle 8,667]

I had a BMI of 39, no "official" comorbidities besides my feet and ankles and knees hurting every single day. Went to Obesity Control Center in TJ, had my surgery with no BS insurance hoops to jump through and six months later I'm at a normal BMI and NOTHING hurts! Just sayin......

[Jersrose43 837]

Appeal rights are listed in your denial letter and if they aren't send it to your local insurance commissioner as an appeal

[Rovobay 920]

keep trying. appeal. hoping for the best. good advise above.

[Stephanie Celeste 8]

Gaining weight.... t

Edited July 5, 2014 by Stephanie Celeste