Why Denied???

[kmt1973 92]

I was denied bc they said my bmi is too low, with no comorbidities. I have diabetes and colesterol. Aren't those comorbidities? Should I appeal?

[NWgirl 574]

What is your BMI? Diabetes, hypertension, high cholesterol, sleep apnea etc are all comorbidities. Usually insurance would rather give you the run around and deny you, hoping you will not appeal. Make sure you satisfy all insurance requirements and if you do, call them and ask why you were denied. If they tell you the BMI was too low (and if your BMI is within their acceptable range, which is usually 35 BMI with two comorbidities or 40 BMI without) but you saitisfy what they say, then you need to appeal.

Sometimes they just want more information. Don't give up. Have your PC write a letter of necessity, if they have not done so already. What do the people at the place you want to get surgery say?

[B-52 7,113]

Yes....appeal. When you have comorbidities, as you do, you follow a different scale than other people.

[ducker2010 17]

My BMI was 49 so I didn't have to have two comorbidities. I do have sleep apnea and high cholesterol though. We had a lot of problems with our insurance. They wanted my primary doctor to do six visits with me and they wanted really specific things noted in her report. Find out exactly what the insurance wants and make sure your doctor puts it in there.

[NWgirl 574]

Just don't freak out! I have read on here about people getting denied for TOO much information provided in the documents. Just realize it's a game, and if you meet the requirements set forth and they still deny you, call the department that oversees insurance in your state and report them.

[#MagicWithinme 173]

my cousin going through same thing, her insurance denied her because of low BMI 31 but she is 6'5 and close to 280. She has cysts on ovaries and takes phen-something for weight which she has been on for over two years. limit is 6 months. her hormones metabolize to where it treats what ever she eats into sugar which resembles diabetes and the insurance won't give her or dr. their guidelines. I told her to appeal and to go back to regular doctors with medical f/u , any other doctor she visited to get weights. With my doctor the more back up information I gave him, he turned it all in with his recommendation to get my lapband done.

Appeal I say! These days we have to be our own health advocates and the insurance doesn't know us.

Good luck

[PWoo10 7]

I think we all get denied the first time. They want to see if we really want it. So appeal. Let them know you want it and are serious.

[BayougirlMrsS 3,939]

I guess i was one of the luck ones that got approved first time out.

I think a lot may also be how your doctor submits your information. My dr. had me do all my visits .... heart, nutritional, pscy, Rn, gastric, sleep study, etc..... they then compiled all the results and a surgery date... and sent in all together as one packet. Couple weeks later i was approved via United Health

I started my process with a free seminar in Aug. and had my surgery in Nov. My BMI was 40.8 with NO co-morbids.

I would appeal..... i also would have the dr. resend everything as one packet with a surgery date

Good luck.

[kmt1973 92]

My bmi is 37. Starting last march with my first dr visit, I did EVERYTHING the insurance requested. I was denied in sept bc they said my obesity is pre-existing. Well duh. So I had to wait for feb to resubmit everything when the required year wait for pre-existing was up. I just had to send in drs notes, one for 08, 09 & 10. Showing my height & weight plus my cholesterol & diabetes treatment. So now just waiting. Thank you everyone that took the time to respond. Its very useful and appreciated. If this is what my God wants. Then it will be.