Rejected by BCBS of Ill.

[mrscrash2u 0]

Just before leaving for holiday vacation, I got the letter from my insurance. They rejected me for not having 2 things wrong along with weight. I called the lady at my doctors office and she said I needed to get sicker. She said I could appeal it or be a self pay at almost $16,000. I have a herina at the same place where the band goes, but she said that didn't count. Couldn't they have told me 6 months ago before paying the $300 for the classes, etc.? I am supposed to see the Phys. next week, don't know if I should go. Any suggestions?

[Northern Mist 2]

I'm almost in the same boat. I have high blood pressure (hypertension) and knee joint pain (arthritis) but that's about it. I don't have diabetes but I was gestational diabetic with both children and I didn't get tested for sleep apnea because I don't really snore. My paperwork should be sent in next week and I'm crossing my fingers.

How long did it take to get the rejection from the day you/your doctor filed? What was your BMI?

Don't give up!! You have the right to appeal.(sp?)

Good Luck!

[Cota129 0]

BCBS IL pisses me off. I ended up being self pay because, even though I am morbidly obese, I am too healthy! In order to be covered I had to be diabetic, arthritic, hypertensive, have high cholesterol, or any number of things. You'd think they'd pay so now so they wouldn't have to pay even higher bills if I had stayed fat and developed co-morbidities.

[Totallytater 1]

You can self-pay with Dr. Kirshenbaum for $9950 including everything. It's a great deal and he is a great surgeon. You ought to see how incredible my incisions look at 3 weeks out. 4 of my 5 incisions are virtually not even visible anymore. The big one is still visible but it looks like a slightly pink paper cut. So far I am very pleased. Good luck to you.

[sharona 2]

I have blue cross in Connecticut. I have arthritis, high cholesterol, and sleep apnea and am 41% BMI. I haven't been approved yet but my physician stated it won't be a problem. This doesn't make any sense that you wer rejected. Perhaps you just haven't been identified with issues yet but have them. I can't imagine if your obese that you don't have degenerative joint disease at your age (50's) which is normal and exacerbated with weight.

I would try again. Submit an appeal

sharon:)

RN/MSN

[mrscrash2u 0]

Thanks for all of your input. I am not giving up yet, I have one more meeting to go to complete my 6 mos. supervised weight loss, if I miss it, I'll have to start over. I'm going to talk to my Primary Care Dr. because I know my cholesterol is very high and has been for some time now, and we'll see about a couple of other things.

I'm not sure what my BMI is, I think it's 35 and I believe it took them about 2 weeks to reject.

[mustlose 2]

My bmi is 35 and I was approved...because it turns out I have mild sleep apnea too. My advice, take all the tests possible, I never suspected I had sleep apnea, but that was the reason I got approved! Good luck.

[4jin 0]

Well I have BCBS GA and my paperwork was faxed on 12/17/07..I feel like they are giving me the run around...today I called for a follow up and after being transferred numerous times I was sent to leave a voicemessage. Hopefully I will get a call back.

[mustlose 2]

well, keep trying and hopefully your persistence will pay off!

[SuzanneG 1]

My BCBS (federal) said that the only co-morbidities they would accept were:

1. Heart disease

2. Lung disease

3. sleep apnea

I didn't have any of those and my BMI was initially 35.1, then during the stressful appeal process it climbed to 37.5 and when I wrote my appeal letter, I included that along with lots of arguments about my health and my life quality that finally convinced them to approve me.

Good luck. If you need to appeal, I'll be happy to share my letters.

[mrscrash2u 0]

Hi All,

I just went to my last class tonight. Spoke to the nutritionist and she didn't understand why my info was summitted to the Ins. because I am still finishing everything up. I am meeting with my primary care phys. next week to start the appeal process. I also double checked what my BMI is and it's 37, not the 35 that I thought it was. So we'll see what happens. I think even if I can't go through BCBS, I may end up being a self pay. I am so ready for this change in my life, but don't really know if I am ready to go into debt.

Thanks for your responses.

[Sunrise 0]

So sorry to hear your situation but don't give up. I have Anthem BCBS of Ohio and they are strict but should check for sleep apena. Mine was brought on by my weight gain. I'm at 250, bmi 41 currently and I have mild sleep apena. So just for that, it's important.

[Walter 0]

If you have coverage for weight loss surgery but were denied by your payer because they didn't agree it was medically necessary, or your BMI was too high, or you weren't morbidly obese for 5 years, or they didn't like your supervised diet documentation or they will pay for a bypass but not a LAP-BAND, did you know Allergan sponsors a program where you can have your appeals handled professionally at no cost to you? Your surgeon can get you an application for that program and we will be able to help you get through this. Our success rate in 2006-07 with this program approaches 90%.

Don't get discouraged and don't pay cash until you have to. FIGHT!

Walter Lindstrom

Obesity Law and Advocacy Center

Gastric bypass - 1994

LAP-BAND - 2003

Weight less now than since junior high school thanks to my LAP-BAND!

[snowbird 2]

My BCBS (federal) said that the only co-morbidities they would accept were:

1. Heart disease

2. Lung disease

3. sleep apnea

Are you sure they didn't just use those as examples of co-morbidities? My husband and I have fep bcbs, and neither of us have any of those conditions, but our insurance paid almost everything for our surgery.

[suecasb 0]

My bmi is 35 and I was approved...because it turns out I have mild sleep apnea too. My advice, take all the tests possible, I never suspected I had sleep apnea, but that was the reason I got approved! Good luck. :biggrin:

What Insurance do you have?