mary.losing

The insurance says you have to have two co-morbidities that DO NOT RESPOND to maximum medical management. So just taking cholesterol meds isn't enough, you have to show that when you took them your cholesterol didn't come down. It's really stupid, but that's what we're working with. I am about to re-submit my claim after working with multiple doctors for five months to try to document it. If it works, I'll let you know.

I have Boeing BCBS too, and was denied last summer. Not only do you have to have the two co-morbidities, you have to show that they aren't responding to maximum medical treatment. I have been working with three doctors since the summer to show a track record. Two doctors have put in my file that my arthritis will only be helped with weight loss. Now I'm working with the sleep doctor because I am having trouble tolerating the CPAP. You have six months to apppeal after they deny you. My surgeon didn't tell me about the not responding part, I thought I only had to have two co-morbidities. I am trying to be very thorough so they will approve me this time. Good luck!

Oldskoolheart, I have BCBS of IL. They turned down my first request because the surgeon's office didn't tell me I needed two co-morbidities that weren't reponding to treatment (my BMI is 37). I am in the process of trying to get that documented. Any advice? How much proof is enough? For instance, I have mild apnea, and am having a lot of trouble tolerating the CPAP, is that enough? Thanks so much.