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Bcbs Of Al Advice Needed!



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I contacted Blue Cross Blue Shield of AL this morning to check on the status of my preapproval only to be told that it had been denied because I had not had a BMI over 40 for 3 years and did not have any of their 5 comorbidities used to determine approval. I asked to speak to the person that reviewed my case and was told that information was not available and that the reviewing doctor would not take phone calls. I was given the address for the pre determination department and told I could write a letter. Needless to say, after 6 months of weight monitoring, a psych evaluation, nutrition class, and general hoop jumping, I am feeling very discouraged. I don't mean to sound like a crazy desperate lady, however, I suffer from fibromyalgia, degenerative discs in my lower back, high cholesterol, and plantars fascitis. I also have a current BMI of 41.

Is there anyone that has experienced anything similar that can give me advice on what to do now. Is it a hopeless cause and I have just wasted half a year?

Thank you for taking the time to answer. I am quite distraught at this point in time.

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Have your surgeon appeal this and meanwhile, write a letter yourself. It sounds like you should qualify. Sometimes insurance companies play these stupid games of denials to much needed procedures for people with these complications. Hang in there and be proactive in seeking approval.... Let us know how it's going. :)

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Have you had a sleep study? If you have sleep apnia and you very well could, then that is one of the ones that helps qualify you. Ask your Dr about it. It may help your case.

Some signs of sleep apnea are .. snoring, stop breathing in your sleep for a few seconds and waking up a lot at night.

Just sayin.....

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Jillb thank you for your response. I did have the sleep study about a year ago. I did not have severe sleep apnea. That is what is required by BCBS. I did have restless leg syndrome but apnea score was only 4 (50 is required by my insurance. Thank you for trying though. :)

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This almost sent me into panic.... I am waiting for them (BCBSAL) 2 respond. Just submitted info Friday.

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Definitely have your surgeon call and have a peer to peer review. Oftentimes, the decision will get reversed. I'm sure your doctor has had to do this before.

Good Luck!!

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Bamagirl~ your sleep apnea score may have changed in the last year. Can you do another test? Just a thought! :)

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I'm so sorry slimshadychick! Didn't mean to send you into a panic.I am sure you will have a better response than me. If not, you will have the advice of a lot of great people trying to help!

Thank you everyone for your responses. Personal letter is written to the insurance company, and I have requested a peer to peer review. My doctors insurance coordinator doesn't think BCBS of AL will do that, but she said she would check on it. Considering the sleep apnea test again. Not sure I would increase that much, however if I recall BCBS footed most of the bill on that last one, so it may be worth a shot. Thank you again everyone for your advice. Hopefully something good can and will come from this.

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Oh no!! All of this just worries me! Why does she think they wouldn't do a peer to peer? ((Hugs)) don't give up! Keep me updated!

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I'm not sure GAmom. She just said it was other insurance companies and out of state BC, but maybe she will find out differently when she looks into it.

I am praying that we all hear positive news soon. Thank you for helping give me encouragement. It has been a very rough and emotional day. I am very disappointed. Just talking it out with people who understand helps so much. I can not thank you guys enough for your help.

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Well got my official denial letter from BCBS in the mail today. I have sent a personal letter hoping the will reevaluate my case. I've never been a squeaky wheel, but I am prepared to "squeak" until they do what's right. Hope it helps!

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Appeal it! Get your coordinator to appeal it. What about a peer to peer?

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Sorry to hear this. Did they say what the 5 comorbidities were? Also if bmi was over 40 for 2012, was it over 40 last year. If yes maybe you could count 2013 as the third year?

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Well got my official denial letter from BCBS in the mail today. I have sent a personal letter hoping the will reevaluate my case. I've never been a squeaky wheel' date=' but I am prepared to "squeak" until they do what's right. Hope it helps![/quote']

Whatever was the turnout on this?

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