As I sit here at work not focused, today I received notice I was denied by Anthem Blue Cross. They feel as though I do not have any life threatening illness due to my weight; UGH. BMI is 36, I have mild sleep apnea, fatty liver disease, GERD, infertility issues, joint pain, ulcers and a long family history of obesity. I am so devasted. My doctor's office has scheduled peer to peer conference call for next Monday.

Has anyone heard of success after a peer to peer review?

Thanks.

Peer to peer interivews can be very helpful.

Sending positive vibes.

They can definitely help. Hope yours goes your way!

I can't speak for the peer-to-peer process, but I can tell you with a BMI of 36, you are barely meeting minimum BMI criteria of 35 and above. Getting approved at between 35 and 40 can be problematic, and usually depends on how your particular health plan sets criteria for that BMI range. It's true that none of the comorbidities you mention are considered life-threatening,

This is not to say they aren't serious - they are. Life threatening comorbidies could be something like severe sleep apnea, diabetes not well controlled with medication/diet/exercise, that kind of thing.

Just hoping to help you understand how the process works. I hope this is helpful.

Edited November 4, 201510 yr by 2goldengirl

Here 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

I'm so sorry! I too am terrified that I've gone through all this with my insurance company for the last 6 to 7 months with co pays and out of pocket money spent to meet the requirements and to possibly not be approved. I hope this peer to peer works in your favor! please keep me updated. I will not know about my approval till they submit my paper work on Nov 13th. How long did it take to hear back from them once they sent it in?

I heard back from insurance company in 3 days.

I should also find out this week if I'm approved or not. I have Preferred One and BMI of 36. I've done everything........it's just a waiting game now. Again, if anyone has any information on the Peer-to-Peer process/success rate, please share.

so sorry to hear this. Peer to Peer can be very useful and some people are approved after a peer to peer. Good luck!!!

I've been approved for Dec 15th! So glad it doesn't have to go to peer-to-peer. Good luck next Monday to you HopefulChg21, prayers coming your way!

Did you find out anything else about your peer to peer?

Any updates to share?

If you can get a diagnosis of obstructive sleep apnea even if it is mild obstructive sleep apnea insurance companies are quicker to approve. Or if you can get a letter from an orthopedic doctor that losing weight could decrease your chances of major joint issues in the future that would be helpful too.