Denied by BCBS Federal with BMI < 40, next step

[peteyrulz 82]

I have been researching self-pay in Mexico since my denial last week. My BMI is almost 39.

Before I commit to a surgeon there, I wanted to see if Lindstrom advocacy

might be able to get me an appeal. They were VERY helpful & told me upfront that they couldn't help because my co-morbidities were not

life-threatening according to insurance and medical circles. (my co-morbs are GERD, depression, and arthritis)

Since my BMI is close to 40, they recommended I gain weight (about 8 pounds) She said once a person hits BMI 40, insurance would be wrong not

to approve WLS.

Has anyone out there been denied with BMI just under 40, then gained weight to reach 40 and get approved? (sounds counter-productive,

doesn't it?)

My trend has been to put on 4-5 lbs every year for the last 3 years or so.

[Pepper123 320]

WOW!!!!..i know someone who was denied and eat like a horse to meet the 40 BMI….she had her surgery two months ago….now i was denied not for my BMI of 35 but for not submitting the pylori results and some blood test….hmmm my surgical coordinator leave mush to be desired….so here i go again getting all the test completed and hoping that my pylori comes back clean….

[SherB 220]

I agree, it does seem counterproductive BUT for only 8 pounds I would go for it. Even going to Mexico is certainly not free. Of course I can gain 8 pounds in about a minute. =)

[MrsVanderbilt 29]

i didn't officially get denied, but i did gain weight to meet the BMI requirement. I was just a few pounds away like you. What was amazing was that it was really hard to gain those 10 pounds. It took me at least a month!

[mz.newlife54 103]

Ok so im right at bmi of 40 with no other problems. What are my chances of being approved with bcbs fed

[gottagonow 82]

Only 8 pounds! Put some leg weights on at your next weigh in and call it done. I hear about being told to gain weight but I just couldn't do it. I got sick and less hungry trying. I was losing weight.

[bikrchk 1,313]

Couple rolls of quarters in your pockets!

[Jersrose43 837]

Stoop a little

[Rena's got this 274]

I had to prove that I had been at or over a BMI of 40 for the past 3 years, which I couldn't, so I had to show that my co-morbidities had been present for 3 years, which they were, but weren't terribly severe. I was denied on the first attempt, so I copied my entire medical records for the past five years and sent in every little thing I could think of. Lots of documents, lol. They approved me the second go round.

[Mellyb251 30]

I second the ankle weights - you can buy them at Walmart and they are not obvious at all under a pair of loose pants. Just to be on the safe side since I was so close I wanted to have that BMI of 40, my doctor didn't notice.

[Pookeyism 1,143]

NO. I would not put on the additional pounds. However, I would submit as much proof on continuous yearly gain, and submit your issues, and anticipate issues. Get tested for hernias, heart issues, asthma, diabetes, peripheral circulation issues - everything - in your appeal

Not sure what the advocacy group is you are referring to - is that associated with your doctor? Insurance? It sounds like, off the top, they are indeed being upfront, but only on not being willing to try very hard past cut & dry approvals.

I know Mexico is a big issue for a lot of people on here, but seriously consider staying on this side of the border for this surgery. Make a payment equivalent to whatever you would have paid for a loan into savings so when or if self pay is necessary you have as much saved as possible. Check with your 401K.

Another thing - the expense of surgery may create a tax refund for you that might make a loan from a family or friend a realistic option, however you really need to get with your accountant over that, to be sure.

I even know of someone here who sold their car to get the surgery. No kidding. For her it was easier to get the new car loan than the unsecured medical loan. Again this is how a financial planner or accountant could be of service, to provide options to get you to your goal.

Good luck!

Edited July 3, 2014 by Pookeyism