I received the call from BC/BS that my procedure was denied due to my BMI being too low. They have my BMI as 36.6, however when I calculate I get 38.73, so I think they have the incorrect weight and height from my doctors office. Although, I have some co-morbidities, I don't have any MAJOR ones so they say I'm not a candidate. I told them so if I gain 6 lbs and have a BMI of 40, I would be approved and they said yes. Well guess what I plan on doing?

My doctors office said they will appeal and if the written appeal gets denied, then they will ask for a peer to peer meeting. I am scheduled for the sleeve on 3/31 so I am hoping the news will change before then or else I will be eating everything in site so I can gain 6 lbs and have a higher BMI. It really SUCKS that I have to gain weight to get approved.

Anyone have any advice on how to get approved without gaining weight?

Oh BTW, I am heartbroken about this denial too. I am a single mom and had it all planned out to have the surgery done the week my kids were on spring break so they could go to their grandmas house so I wouldn't have to worry about getting someone to bring them to school and back etc. I don't know what I will do if I can't have this done at the end of the month.

Awww talk to your surgical coordinator she or he should be able to help!!!…good luck!!

Thank you Pepper123 but the surgical coordinator is the one that said she would submit the written appeal and if that got denied she would submit for a peer to peer review/meeting

I would talk today (if possible) to the insurance person about timing. My kids are older now, but I remember all the planning for stuff around the kids school schedule. If you haven't already let them know how important the date is, it might be a good idea to do so.

Also, write a letter and email it to the insurance company. Tell them about your journey and why you are seeking surgery. Tell them about the co-morbidities you do have and how it negatively affects your life. Tell them how you feel it is counter-productive to gain 6 pounds just to be approved.

Honestly, I completely get that you don't want to gain weight. That being said, I could easily gain 6 lbs in a weekend! Lol.

Edited March 9, 201511 yr by samuelsmom

@ samuelsmom, thank you for your advice. I have written an appeals letter and emailed it today. I also called the case manager and left a message. Of course she called me back but I missed the call because I work in a hospital myself and was tending to a patient. Called back again and left another message.

The surgical coordinator also contacted me saying she called the case manager on Friday and left a message but hasn't heard back. She will try again this afternoon if she hasn't heard anything.

And yes I think I could easily put on 6 lbs over a weekend as well.

Wish me luck!!!

I gained in order to qualify and it was all worth it I lost what I gained just on the pre op liquid diet. Good Luck

@cdenny123, thank you because I think that is the route I will have to go down.

Did you gain before the 1st consult or during the "supervised diet" nutritional visits?

Do you know if they base this on your first /original weight or the most recent?