Need Advice - Denied for BMI 40.6

[Graceful One 4]

Hello everyone,

My bestfriend is in the process of getting approved. She was denied by LINECO (BC/BS of IL POS) for only having a BMI of 40.6.

She was also told that she has to have 6 months of medically supervised weight loss attempts (yet they will not pay for a nutritionist).

When she stated that the FDA approval is 35 with significant co-morbidities and 40 is indicated without, the claims person told her that because the group is self-funded she needs to have a BMI of 45.

Along with her 40.6 BMI she has high blood pressure and PCOS/Insulin Resistance.

Does anyone have any advice I can pass along?

[Alexandra 55]

The fact that the group is self-funded does mean that, to some extent, they can set their own rules about what's covered. The good news is that they can also bend their own rules the same way.

I think your friend's best bet is to find someone within the organization who can help her make her case to the right people. She may have to be willing to "go public" if need be, unfortunately. Wish her luck for us!!

[mello_one 0]

Try this website which has wonderful advice on how to appeal. http://www.obseitylaw.com Good luck to her.