raec81

Thank you so much!

My first attempt at approval was a long, disappointing headache. We submitted to BCBS and they denied it saying I didn't have a co morbid when their criteria clearly stated BMI of 40 and greater or 35 and a co morbid. At the time mine was around 50. We appealed and proved our case but they then admitted I was a candidate but denied it due to administrative error. There were no errors. The next option was a state fair hearing which we pursued to get the run around. By this time it was open enrollment so I switched to WellCare. During all of this I finished the 6 month diet because BCBS only required 3. My insurance started the 1st of January. My doctors office submitted my packet on the 5th. Yesterday! This morning we got the approval. I am beside myself right now. I go in Thursday to get a date!

I wanted to wish everyone a Happy New Years! For those who got approvals/surgery in 2014 Congrats! For those still working on it like myself keep pushing on! Here's to 2015 giving us the answers we're looking for after months of hard work!

Oh ok I don't really know anything about them. I have Anthem BCBD through Medicaid in KY and it's been nothing but a headache. I am on the state fair hearing step.

What state are you in? Also is this a work plan or Medicaid?

It didn't change. My office contacted someone high up in the Medicaid office here and they said it didn't. Even though they denied my appeal due to administrative errors they said in the letter that I qualify but this this and this which were all administrative errors. How close are you to submitting to insurance? Good luck!

It seems to be a little of both. Some information that was submitted to them was left out of the packet. Also the doctor has always pushed for the band so when the packet was submitted it has both sleeve and band checked when I stressed on more than one occasion to the person doing the paperwork that I was only interested in the sleeve. Overall he seems like a good doctor but the way he shoves the band down your throat makes me think of a shady used car salesman. I understand they each may have their preference but once a patient picks let it go. Especially don't mark both on my appeal paperwork! Aside from the pushy attitude in regards to the band I like him and his staff.

Has anyone switched doctors during this process? My current doctor messed up my appeal that they submitted on my behalf. With open enrollment I am switching insurance so I have another chance and want to switch doctors. Has anyone done this? I'm so frustrated with.

Grats!

Yeah most of the Cigna people on here are approved prety fast. Good luck!

So my appeal was submitted and we are waiting to hear back. They have 30 days to respond and we're on day 20-25. I was wondering if anyone has been through an appeal had to wait that long and still get a yes or is this a bad sign that they are dragging it out? Any personal experience shares would be appreciated!

I live in KY as well and I've heard WellCare is one of the easiest to deal with and usually pretty quick.

What state are you in?

Thanks. I think venting helped some lol

I have KY Medicaid with my MCO being Anthem BCBS. I was required to do a 3 month diet as well as a few other things. The criteria they stated was 35+ and 1 or more comorbid OR 40+ with no co requirement. I fall into the second category. We completed all requirements and submitted the paperwork. They denied me! They stated a Medicaid change now requires all to have a co regardless of bmi which is not true. My doctors office contacted Medicaid directly to check on this and got confirmation nothing had changed. We are currently appealing. I'm so frustrated I could scream. Time seems to crawl by while I'm waiting.

I would have the Doctors office request this. My insurance did the same thing but when they requested it they sent it right over.