i won my appeal scheduled for 4/28

[Robbiehage 1]

Congratulations! How exciting that you won your appeal.

[mp8btpc 32]

That is awesome and that should be helpful to those with BC/BS California knowing they can always try that route!

[sleevegenie 0]

i'm sorry, i'm a little confused, Aetna approves the sleeve, why were you declined? the letters i have are based on them saying it is still investigational,

[Missnursette 1]

Well, Aetna's requirements to have WLS is that you have to have had a BMI over 35 for at least 2 yrs. My BMI in 2007 was 36, but I lost a little weight within the 2 yrs bringing my BMI to 34 off and on.. Now they are saying my BMI was not >35 consecutively for the 2 yrs, but what upsets me is you have to prove you tried to lose weight!!!! Well, I did, but gained it back every time!!!! So anyway, I have been denied twice and sent my last appeal last week. On July 1, our insurance changes to Anthem BC Calif. and I will have to start dealing with them. They do not have all of the requirements Aetna has, and should get approved a little easier, but then they don't cover VSG! They cover lapband and gastric bypass, which I really don't want. So, I am in the middle!!

Thanks! I appreciate any advice!

[sleevegenie 0]

i'm pretty sure that after this bariatric conference in june they will no longer be able to say it is unproven, that's just no longer true, but i'm not sure about the bmi, i would advise you to call and ask them, i thought it was bmi over 35 with co morbidities for 5 yrs. but i could be wrong, my problem was not that, mine was they say the sleeve is still experimental, and like i said, just no longer true, i won my appeal. best of luck to you,

[gsegura 1]

Congratulations, I'm also in California and have Blue Cross. Could you please tell me how did you get approval with such a low bmi? I'm under 35 bmi with health issues and I don't know how to approach them. I would really appreciate your advise and I wish you the best on your surgery. Gloria

[sleevegenie 0]

hello, i didn't get approved by anthem blue cross they denied me, but in Cali we can appeal to the state, requested an independent medical review, which i did and won, but bmi over 40 is the rule or if you have co morbidities then bmi over 35, so i have had bmi over 35 for at least past 5 yrs, i also have co morbidities , i'm sure you can have the surgery if you pay for it yourself, but don't think insurance will without bmi over 35 for at least a couple of years, best of luck to you, ) jeani

[gsegura 1]

Thank you for your response Jeani, My best wishes on your surgery.