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Blue Shield Of California Ppo

Hi,

I have a bmi 37 and my doctor just diagnosed me with mild sleep apnea. Does this help my chances of getting approved? I also have one kidney (donor) & had gestational diabetes with my last baby.

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  • Meli1234, Thank you! Thank you! You just gave me the hope I've been looking for I hope BS does the same for me!

  • Hi, I really hope it works for the both of us. Lord knows how much I need it! I called my coordinator and they stated its now an open appeal and they're communicating with my insurance company so, t

  • hey, yes, that sounds very reassuring of an approval I'm sure you can't wait!! I'm hanging in there. It's just so hard because I have doubts. I feel like I'm going to be denied again. wishful th

Featured Replies

  • Author

Kiki,

Thanks for the response. I had gestational diabetes along with sleep apnea. Glad you were approved :) did they contact you or did you call the insurance the next day?

Thanks,

Denise

My insurance company called me before the doctors office called. Good luck, I am sure you will be approved. :)

Well good for you keep us posted. Wish you the best.

  • Author

thanks for the good hope and info.. thats awesome your having your surgery soon :) yes, please keep us posted!

  • 2 weeks later...
  • Author

Hi,

I was just told that I have been denied! :( I'm so disappointed!! My coordinator I going to try and set a peer to peer and if not she will have to appeal. Just thought I'd update.

Thanks,

Denise

Hi' date='

I was just told that I have been denied! :( I'm so disappointed!! My coordinator I going to try and set a peer to peer and if not she will have to appeal. Just thought I'd update.

Thanks,

Denise[/quote']

Damn!!

What was the reason given for the denial?

  • Author

Hi,

The reason was "not medical necessary". I don't understand. I had gestational diabetes, only have one kidney, and I have sleep apnea. I have been over weight most of my life. My father had diabetes, high blood pressure, renoplasty (spelled wrong but can lose his eye sight at any time from diabetes), kidney failure, and more from being over weight. My doctor for the past 11yrs. Recommended this procedure because he's seen my struggles and knows I'm headed down the same road as my father. I'm so sad and disappointed :(

Thanks for responding,

Denise :)

Hi' date='

The reason was "not medical necessary". I don't understand. I had gestational diabetes, only have one kidney, and I have sleep apnea. I have been over weight most of my life. My father had diabetes, high blood pressure, renoplasty (spelled wrong but can lose his eye sight at any time from diabetes), kidney failure, and more from being over weight. My doctor for the past 11yrs. Recommended this procedure because he's seen my struggles and knows I'm headed down the same road as my father. I'm so sad and disappointed :(

Thanks for responding,

Denise :)[/quote']

Gotcha.

Damn... Don't give up.

I am also a low BMI patient (just over 35), with few comorbidities. The main thing for me is that my lapband has slipped, and needs to be removed. I was hoping to have a band to sleeve revision. Maybe the insurance will figure that since the surgeon will be in there anyway, he might as well sleeve me...

I've been told BCBS PPO is among the easiest to get approved, but maybe not.

Keep us informed as to what's going on.

  • Author

Hey,

I heard the exact same thing about my bcbs. I think it just depends because a lady on here had gestational diabetes and was approved just with that alone. Thanks, I don't plan on giving up. I'm hoping my physician and/or coordinator will fight with me. They really thought I was going to get approved first time around. I wish you lots of luck. It makes sense to do the procedure well taking out the band. Keep me posted :) and thanks again for responding to my post!

Denise :)

Hey' date='

I heard the exact same thing about my bcbs. I think it just depends because a lady on here had gestational diabetes and was approved just with that alone. Thanks, I don't plan on giving up. I'm hoping my physician and/or coordinator will fight with me. They really thought I was going to get approved first time around. I wish you lots of luck. It makes sense to do the procedure well taking out the band. Keep me posted :) and thanks again for responding to my post!

Denise :)[/quote']

Absolutely!

We're in this together.

Helleva, sorry to hear that, now I'm worried. Its been just over a week since my papers was submitted and I haven't heard anything. Hopefully they will get you approved soon. I don't know why some people get approved and others don't. I have so much aniexty right now.

  • Author

Oh gosh I know! Its so nerve wrecking :( I had so much hope reading others approvals. I don't get it. Thought I'd be approved. I waited 5 days then I called my insurance. I didn't get the denial until today though. I really hope you get approved :) please keep me posted on your situation. Best of luck!

Denise

Thanks Denise, I sure will, also keep me posted. I was so looking forward to having a sleeve buddy.

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