Denied

[sunshine210 13]

I just received the phone call from insurance and I've been denied. I have anthem BCBS, a bmi of 35.8 with moderate sleep apnea. I've been told my surgeon is going to do a peer to peer with the insurance company but wondered if I have any chance whatsoever of being approved. I wish I'd been told initially to forget it but now I've jumped through all the hoops only to receive this devastating phone call. All pre-op testing was completed, all pre-op appointments are scheduled, surgery is scheduled for 3 weeks from today, Protein Powder is purchased. Any input or advice is welcome. So very disappointed.

[Jacqbult 112]

Okay. That sucks. Really, don't give up hope yet! Many times the Dr can help during that peer conversation. Make sure to tell the Dr ANY thing that your weight is effecting..knees, hips, breathing. Cholesterol. Fingers crossed for you! If for any reason you still get denied gain a bit of weight and re submit. Keep us posted!

[raec81 18]

What state are you in? Also is this a work plan or Medicaid?

[sunshine210 13]

NJ and its a work plan

[raec81 18]

Oh ok I don't really know anything about them. I have Anthem BCBD through Medicaid in KY and it's been nothing but a headache. I am on the state fair hearing step.

[Bruce Peter 39]

I have a 37.5 BMI with sleep apnea and diabetes. It's been three weeks with no answer yet. I have Aetna. I hope you beat this and get yours covered

[peteyrulz 82]

Don't give up! I've been denied twice with BMI < 40 but I feel positive about my third try. I had NO apnea, HBP, or diabetes, but I have other co-morbs. I hired Lindstrom Advocacy (wlsappeals.com....not affiliated). They are wonderful...their phone # is on website. They can give a free phone consult & will let you know if they can help you or not. Very reasonably priced. Hopefully a peer to peer will be successful. Good luck!

[Miss Mac 6,261]

Here is a list of co-morbidities that you may not have thought of. The list is from www.nih.gov , the National Institute of Health which is a government affiliated entity. I also submitted a letter outlining all of my co-morbidities and how each one had a negative affect on my quality of life. Don't give up. Be a woodpecker and peck at this relentlessly until you get what you want.

Obesity Comorbidities

To follow is a list of comorbidities (additional conditions or diseases) related to obesity which may help you in qualifying for weight loss surgery.

• Family history of heart disease

• Family history of stroke

• Family history of diabetes

• Family history of heart attacks

• Hyperinsulinemia

• Diabetes

• High blood pressure

• Coronary-artery disease

• Hypertension

• Migraines or headaches directly related to obesity or cranial hypertension

• Congestive heart failure

• Neoplasia

• Dyslipidemia

• Anemia

• Gallbladder disease

• Osteoarthritis

• Degenerative arthritis

• Degenerative disc

• Degenerative joint disease

• Recommended joint replacement from specialist

• Accelerated degenerative joint disease

• Asthma

• Repeated pneumonia

• Repeated pleurisy

• Repeated bronchitis

• Lung restriction

• Gastroesophageal reflex (GERD)

• Excess facial & body hair (Hirsutism)

• Rashes

• Chronic skin infections

• Excess sweating

• Frequent yeast infections

• Urinary stress incontinence

• Menstrual irregularity

• Hormonal abnormalities

• Polycystic ovaries

• Infertility

• Carcinoma (breast, colon, uterine cancer)

• sleep apnea

• Pseudotumor cerebri

• Depression

• Psychological/sexual dysfunction

• Social discrimination

• Premature death in the immediate family

[bobbyswife 862]

This terrifies me. I have Anthem BCBS in GA. My surgeon says everything will be a.o.k. but now I'm worried! Everything is being submitted to them tomorrow... I'm scheduled for 12/18

[mrsbailey921 117]

im so sorry you were denied. i do know that many BCBS plans work similarly (including the Medicaid plan--Horizon NJ health) and they are huge sticklers about having particular comorbities if your bmi is below 40. why exactly were you denied? what was their reasoning?

[sunshine210 13]

My surgeon did a peer to peer with the medical director at my insurance company and was able to get me approved 2 days after the denial. Apparently they had not received the paperwork that I have HBP. So, I'm on for Dec 3 and beyond nervous.

[mrsbailey921 117]

ok, great! congratulations!

[laurenella82 625]

Great news! Congratulations and blessings for your surgery!

[Bruce Peter 39]

sweet!

[cdenney123 103]

Congrats thats great news I was denied as well and when I got the approval I cried I was so happy..