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What? Why So Confusing



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So I thought we sent the request for external review with the IRO. Well UHC denied my 2nd level appeal. So have to submit AGAIN to get it to the IRO. What the crap????

Sorry, insurance is sooooo screwy some times.

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I never even made it that far. My insurance (Anthem BCBS of Ohio) policy had an exclusion for anything weightloss. I got a very flat and resounding "NO". In a way I think it was a blessing in disguise as I feel I saved myself lots of time and headaches by deciding to pay for it myself. I am scheduled in February with Dr. Ariel Ortiz at Obesity Control Center in Tijuana, Mexico. Don't give up..even if insurance refuses again there are other options! :)

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So I sent in the request for external review this morning. 58 pages of diagnosis, medical studies, tests, letters, ect. Also wrote a three page letter about why this surgery is needed. Doc office should be sending in their portion today too. Hope they see the benefits of surgery for me.

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I never even made it that far. My insurance (Anthem BCBS of Ohio) policy had an exclusion for anything weightloss. I got a very flat and resounding "NO". In a way I think it was a blessing in disguise as I feel I saved myself lots of time and headaches by deciding to pay for it myself. I am scheduled in February with Dr. Ariel Ortiz at Obesity Control Center in Tijuana, Mexico. Don't give up..even if insurance refuses again there are other options! :)

Dr. Ariel Ortiz is amazing!! That man has changed my life and I am a true advocate! I had my surgery April 16th and I am down 113 lbs so far!! Truly the best decision I have ever made!!!

Good Luck!

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I have BC/BS of Alabama & was denied immediately ( after the required 6 mos nutrition visits, psych eval & so on) because bmi was not documented @ 40 for 3 yrs, & the nutrition visits not signed by PMD . BMI 37 to 38 for 10 yrs... No where in the policy did it say any of this !

Have decided to pay out of pocket using other resources. It is worth it at this point. There was no way to appeal.

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Oh no melissa im also using bcbs of alabama...i hope I dont have this issue also....im sorry your having problems

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Insurance called to let me know my external appeal has been sent and I will know the final decision in 30 days.

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    • Theweightisover2024🙌💪

      Question for anyone, how did you get your mind right before surgery? Like as far as eating better foods and just doing better in general? I'm having a really hard time with this. Any help is appreciated 🙏❤️
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      1. NickelChip

        I had about 6 months between deciding to do surgery and getting scheduled. I came across the book The Pound of Cure by Dr. Matthew Weiner, a bariatric surgeon in Arizona, and started to implement some of the changes he recommended (and lost 13 lbs in the process without ever feeling deprived). The book is very simple, and the focus is on whole, plant based foods, but within reason. It's not an all or nothing approach, or going vegan or something, but focuses on improvement and aiming for getting it right 80-90% of the time. His suggestions are divided into 12 sections that you can tackle over time, perhaps one per month for a year if a person is just trying to improve nutrition and build good habits. They range from things like cutting out artificial sweetener or eating more beans to eating a pound of vegetables per day. I found it really effective pre-surgery and it's an eating style I will be working to get back to as I am further out from surgery and have more capacity. Small changes you can sustain will do the most for building good habits for life.

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        That sounds awesome. I'll have to check that out thanks!

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