BCBS of Pennsylvania have denied me twice, said they don't have to offer external review because my plan is "grandfathered" and not subject to the healthcare reform laws. My BMI is high 35/low36 and I have hypertension and am on 2 meds ...although I completed EVERY step of the insurance requirements and met all requirements, I was denied becasuse my "hypertension is controlled with medication". My surgeon's office was stunned because they are on top of all the documentation requirements and have NEVER had a denial when all the requirements were met.
I'm currently working with Lindstrom Obesity Advocacy to see what my options are www.wlsappeals.com. They are VERY knowledgable. But I have been working on the denials and appeals for months.
So, I am deciding to take control and have been saving like a fiend. If I don't have a definative answer yes or no, I am on my way to MEXCIO! Then I will be in control of what I am getting for my money and when I get it.