I have a bmi of 35 and was recently diagnosed with hypertension. I am now on medication. I have a family history of obesity, heart disease, high blood pressure,cancer. I completed all of my requirements and my surgeon sent in my info. BCBS denied me because they said my hypertension is controlled by medicine. My surgeon is going to schedule a peer to peer. I was wondering if anyone has a similar profile and were eventually approved. It is so disappointing.

Sorry to hear about your denial... I'm going for my first appointment tomorrow... This is the third surgeon I'm consulting with... I too have BCBS, this entire your approved/not approved is out of control... I feel like I'm applying for a mortgage rather than seeking a treatment for a disease... Always been approved when I went for a mortgage... Hopefully the doctor will have some success with his peer to peer

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I have a bmi of 35 and was recently diagnosed with hypertension. I am now on medication. I have a family history of obesity, heart disease, high blood pressure,cancer. I completed all of my requirements and my surgeon sent in my info. BCBS denied me because they said my hypertension is controlled by medicine. My surgeon is going to schedule a peer to peer. I was wondering if anyone has a similar profile and were eventually approved. It is so disappointing.

That's ridiculous. Most chronic diseases (comorbities) can be treated pharmacologically. Hopefully you Peer To Peer will be successful. Sometimes I wondered who the hell is approving/denying these.

I called BCBS and got in touch with my nurse case manager... I asked her to clarify the requirements... After she told me I said your policy doesn't state XYZ that you just said, can you explain why what's in writing is different from what you say... No joke, her responses was "I don't know that's what I tell everybody"... I said you got to be kidding, please give me the number of the supervisor... About half hour later the supervisor called, I said can you please explain to me why the nurse handling my case have no idea what my policy states as the requirement... I got some political correct answer... I went on to explain my story to her...she kept stated things that weren't in writing either, when she could talk her way out of it she changed the topic to the fact I needed the NUT and PSYCH visits... I said I'm well aware of that I called you to discuss your 6 month weight management criteria of which you don't even seem to know what things would meet that criteria... Personally I feel when you the peer to peer is done you will be approved...

The answer is those reviewing the case don't have a clue.

The policy state you need commodities, mine doesn't say anything about if it can be treated with meds or not. I go by what's in writing.

I would write my own letter to protest the denial asking them to provide where in the policy does it state anything about meds.

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Edited May 24, 201610 yr by nyteacher125

@ I got nowhere with BCBS either. They told me that my surgeon will have to tell me what the requirements for BCBS to approve authorization. If the incompetent Rep I spoke to have me the correct info when I initially called - I would have already had surgery!

I have the copy of my actually policy so as I spoke on the phone I said what page is that information on? Both of kept saying does the policy you have say whatever it was on the top... Yep it says that, oh was the response... That's another game, the surgeon will tell you, all that means is if the surgeon was to get paid for a few nonsense office visit that's his choice... I'm in NY, where are you?

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Edited May 24, 201610 yr by nyteacher125

RI ... hopefully the approval will go smoothly once submitted.

We'll see... Keep an eye out for my post that says yeah I'm approved lol.

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We'll see... Keep an eye out for my post that says yeah I'm approved lol.

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I will keep an eye out too!

Thanks!

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@ I got nowhere with BCBS either. They told me that my surgeon will have to tell me what the requirements for BCBS to approve authorization. If the incompetent Rep I spoke to have me the correct info when I initially called - I would have already had surgery!

It is so frustrating that the insurance companies can't accurately answer questions.

You don't want to get me started... This entire thing is BS, it's all to discourage people... The insurance company rather see you dead, it's cheaper or maybe not depends on the cause of death lol

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I agree it is extremely hard to get any info from insurance. The only reason I know everything I need to do is because my surgeon coordinator told me and has forms for everything. Whenever I call bcbs they tell me the generic crap and when I ask for details that have no idea what they're talking about and basically say they don't know.

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I'm very frustrated, I have BCBS HMO. I have followed the criteria to the T Know they're saying they are missing documentation. I recieved the letter to and now the nurse case Manger will not answer my calls. I called BCBS and told them I want to appeal but I was told it was not "actually " denied. My next step is the insurance commissioners.