Anyone denied AND they meet ALL criteria/co-morbidities

[SleeveToBypass2023 2,680]

On 5/19/2022 at 7:53 PM, suzannethemom said:

YES, I was initially denied. I have BCBS of Minnesota. My BMI was 38.1 with two co-morbidities (pre-diabetic and high blood pressure). They DENIED surgery because I take BP medication and therefore my blood pressure is under control and no longer a risk. That is so ridiculous! Fortunately, the bariatric office manager fought for me and argued with them. BCBS approved me the next day. I had surgery on 4/12/22.

That's so surprising. I was on bp meds and diabetes meds and was controlled on them, but they were still counted as comorbidites. Maybe it's because you only had pre diabetes and not full blown yet, so they didn't count it. And they usually require 2 comorbidites when your bmi is below 40. I'm really glad your office manager fought for you and you were able to get the surgery. How are you doing since you had it?

[suzannethemom 121]

16 hours ago, SleeveDiva2022 said:

Maybe it's because you only had pre diabetes and not full blown yet, so they didn't count it. And they usually require 2 comorbidites when your bmi is below 40. I'm really glad your office manager fought for you and you were able to get the surgery. How are you doing since you had it?

I also had severe GERD, which some insurance companies consider a comorbidity. I think that BCBS was just being mean and looking for an excuse because my starting weight was on the lower end (223 pounds).

I am doing okay on week 7 after surgery. Every day is a struggle to eat the right things and stay away from crackers. I discovered that I can very easily eat Skinny Pop popcorn, Goldfish crackers and Cheez-Its. Now I’m addicted and trying really hard to resist them. They are now banned from the house!

[Mariann812 268]

4 minutes ago, suzannethemom said:

I also had severe GERD, which some insurance companies consider a comorbidity. I think that BCBS was just being mean and looking for an excuse because my starting weight was on the lower end (223 pounds).

I am doing okay on week 7 after surgery. Every day is a struggle to eat the right things and stay away from crackers. I discovered that I can very easily eat Skinny Pop popcorn, Goldfish crackers and Cheez-Its. Now I’m addicted and trying really hard to resist them. They are now banned from the house!

CIGNA approved me. i met the criteria but i think they approved me because the hiatal hernia that has to be repaired is 'massive' to use my surgeon's words. The recommended repair procedure for a hernia this size IS gastric bypass. My gallbladder will be removed as well.

I was careful to keep my BMI right at 40. My surgeon had a sleep study done, and I now have a CPAP machine for sleep apnea. coupled with high blood pressure, cholesterol, I guess I sailed through approval.

However, the hernia is causing shortness of breath. Half of my stomach is in my chest and it is pressing on my heart and esophagus. It probably begin 21 years ago when I was pg with twins.