Peer to Peer review

[vandernoordh 63]

So as of April 18th I was denied due to lack of having a co-morbid health condition. (I have to have a BMI of over 35 with 1 co-morbid condition) I am a prediabetic, I have high cholesterol, and I have a fatty liver, but these are all not considered co-morbid conditions?! I'm a mess after finding out I was denied, but my Dr has set up a peer to peer review for May 3rd. Has anyone heard of gaining a successful approval after the peer to peer review?

[KristenLe 5,979]

Yes - many peer to peer reviews overturn the decision.

[Kelly1121 26]

How did the peer to peer go? Was it overturned?

[vandernoordh 63]

Nope...I still need a comorbidity even though my BMI is over 40

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[MuffinzGamma 7]

Nope...I still need a comorbidity even though my BMI is over 40

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What insurance do you have? That is my biggest concern EXACTLY what you said - no sleep apnea, "pre diabetic", high cholesterol and hovering 40 BMI. I have Meritain thru Iasis Healthcare a division of Aetna. I would think if diabetes is diagnosed with A1C at like 6.5 generally and i am at 6.4 and 6.2 this last lab draw it would suffice meeting criteria of a co-morb ugh! O guess time will tell planning for surgery hopefully in Sept.

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[vandernoordh 63]

I have united health care. Since this post I have had a sleep study done and I do have sleep apnea. I'm just waiting for the Drs office to get back in touch with me to complete the appeal process.

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[Amurillo04 109]

I hope it all works out for you!

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