BCBS CA PPO Appeal - Lap Band

[Sunbunnie 0]

Greetings everyone!

I'm new here and thought I would seek the advice from those that have been successful in the appeals process.

My health insurance is BCBS CA PPO which covers the various types of weight loss surgery and I live in Nebraska.

Today, I spoke with the Utilization Review nurse assigned to me. She advised that since my BMI is 37.5, and we discussed my co morbidities (hypertension, depression, asthma, Migraines & joint pain). She advised that I will be denied as my BMI is below 40 and that I do not have the necessary co morbidities. Despite taking 11 different medications. In fact she advised that I need to be on two medications (I currently take 1) for hypertension in order for that to be taken into consideration. In addition, she said that she could not issue the denial but would be sending my file to the next level (a doctor) to issue the denial.

Has anyone had BCBS CA PPO approve lap band surgery with a less than 40 bmi? Would you be willing to share your appeal letter?

Any assistance would be greatly appreciated.

[luckytiger 0]

hi...i live in los Angeles with bcbs ppo....what was your final outcome??

tiger