My surgery application was denied by Fed BCBS.

[cyndi990 31]

My paperwork was submitted December 21, 2016 for approval. Jan 3rd 2017 I called and found out I was denied, because I don't meet the New guidelines for 2017. I am really upset about it ????.

I don't think it's fair. Now I need 2yrs bmi >35 w co mobilities 40> w out co mobilities. 90 days NUT , psych eval. I have NUT class and psych eval but I need 1full year with BMI >40.

Has this ever happened to anyone.

Any advice would be appreciated.

Thanks

Sent from my SM-J700T using the BariatricPal App

[Missymayor 12]

That scares me to death! I have the same insurance. My last appointment is Monday.

Sent from my SAMSUNG-SM-N910A using the BariatricPal App

[cyndi990 31]

Don't worry about it everything going to be ok you will get approved. My situation is different I only have 1 yr bmi of 40 and I need two yrs.

Best of luck.

[erica_ozzy73 241]

Wow.... how is everywhere so different?.

Sent from my iPhone using the BariatricPal App

[trekker954 421]

I was approved by BCBS Fed in 2016. I was required to show 2 years of BMI history. I didn't think the policy changed at all from 2016 to 2017. If was submitted DEc. 21 - they should have processed it in 2016.

[cyndi990 31]

Well the doctor is going to do a peer to peer review , hopefully they will approve it. If they still denies it I have to make a decision pay for the sergury myself or wait 10 months to qualify. Any advice?

Sent from my SM-J700T using the BariatricPal App

[Little Green 583]

Wow! I'm very ignorant about WLS approvals (though very familiar with dealing with health insurance for long-term disabilities) so forgive me for speculating but it seems strange they would hold an application submitted in 2016 to standards that were not in effect until 2017. Maybe they held onto it so they could deny it for that reason... or maybe I am just skeptical of insco's! I hope you get a good result from the P2P with your doctor.

[cyndi990 31]

Thank you .

[fatgirlfreed 42]

Don't worry about it everything going to be ok you will get approved. My situation is different I only have 1 yr bmi of 40 and I need two yrs.

Best of luck.

Exactly why I just decided to book for Mexico. ugh!

[cyndi990 31]

What's the name of your doctor?

What about follow up after sergury?

[cyndi990 31]

I read that if have any comlacation the insurance company will not cover it.

[rharris75 41]

I have fed BCBS also and was denied for the same reason so on to self pay it is

Sent from my iPhone using the BariatricPal App

[Djmohr 6,965]

I had my surgery two years ago now through Medica. I had to show a 2 year history with BMI over 35 w/comorbitities or 40 without.

Also I had to have 6 months of supervised diet.

These insurance companies are all so different. My insurance now covers absolutely nothing. In fact, my annual blood work wasn't covered because my PCP used the word bariatric in her coding. It cost me 2300.00

I had to go back to my bariatric center and ask for a letter showing medical necessity for annual metabolic nutritional panels. This happened in June and I had to pay it or they would send it to collections. So I paid it, and ever since I have been working on the appeal so I can get my money back.

you have to stay on top of them both before and even years after your surgery.

Maybe someday they will change all this so that they cover it on all insurance. (Yes I know I am dreaming)

This is a metabolic disease after all.

[Redmaxx 740]

WOW! I guess I got lucky and was approved in September 2016 by BCBS FEP. Sorry that they denied you.

Sent from my iPad using the BariatricPal App

[ready_to_be_thin 179]

You know, I just have to say this....I don't understand insurance companies. Doctors and insurance companies are so quick to say that our health problems are due to being overweight, but the insurance companies refuse to pay for anything weight related. Can't they see that if we weren't so overweight, that we wouldn't have as many health problems, thus they would save money?? I just can't understand how they haven't come to this conclusion yet. UGH!! I had to pay for my surgery out of pocket. They won't cover anything weight related at all. So ridiculous.