Denied By BCBS HELP

[Broughtkar 1]

I was denied by my insurance because in one of the years submitted my BMI was 39. I have GERD, moderate sleep apnea, and have had two hip surgeries but they claim that this isn't medically necessary. Further, I found out that my primary has been recording my height wrong for years which if corrected in my records, will put my BMI over 40 for all three years submitted. Can anyone tell me how to proceed?

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[trekker954 421]

Bcbs will require your apnea to be medically documented, is it? If not, go get a sleep study. GERD and hip issue are not of interest to them. Go to the BCBS requirements to see what you need. If you have no other medical issues they will require a 40 BMI.

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[clc9 644]

Talk to your surgeon's insurance coordinator and ask them to resubmit with the new information. Get the new info documented in a letter by your PCP.

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[goldenwhisper66 12]

Ya mine (37)says . I have to have sleep apnea , high blood pressure , high cholesterol, diabetic..asthma. .or something .. they're gonna schedue ..I have BCBS.I go Tuesday for my 2nd appointment. Meet nutritionists, have physical& psychologist

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[goldenwhisper66 12]

Check out Illinois Bariatric Center.

They may be an option .

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[chryss 61]

This makes me nervous to hear. I also have BCBS. I bounce from 36 BMI to over 40. I also have GERD but in the last year am medicated for high blood pressure and high cholesterol. I'm hoping my HBP will help my approval.

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[fat76 8]

I have Blue Cross Blue Shield of North Carolina which one did you have

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[brandiddy 9]

I have bcbsnc state health plan. I was just approved. Even if your BMI is 39, they would still cover it if you have other comorbidies(sp?) So if your sleep apnea is documented there is no reason they should have denied you, unless for other reasons. Talk to your PCP and insurance coordinator. They have recently updated the policy so you do not have to have weight documentation submitted. They leave it up to the surgical team.

BTMOMOF3

Edited January 29, 2017 by brandiddy

[brandiddy 9]

BTMOMOF3

Edited January 29, 2017 by brandiddy

[fat76 8]

So are you saying we don't have to have the six-month pre-authorization

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I am from Michigan where are you from

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When are you having your surgery

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[brandiddy 9]

I didnt. My first visit was December 16th. All my appointments were scheduled within 2 weeks and my upper endo was done 2 weeks ago. I was approved last week.

BTMOMOF3

Edited January 29, 2017 by brandiddy

[fat76 8]

What if it turns out you don't have sleep apnea

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[brandiddy 9]

I dont. The original poster of this thread does. I was just giving my experience and knowledge of what I've been going through with my insurance. My BMI is 41, but I also have HBP that is resistant to medication.

BTMOMOF3

[fat76 8]

My first appointment was in December also I've had my upper GI test but it said I was scheduled for six months of pre-authorization

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Was told in my booklet that they gave me that it was an insurance requirement

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[fat76 8]

Where are you plan on having your surgery done Dr verseman is doing mine here in Michigan

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