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Approval with low bmi and no comorbidities?

TJ1257

By TJ1257, in Insurance & Financing

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TJ1257    11

TJ1257
Posted

Goodness that is quite the journey !! Well the very best of luck to you. I'm in my 4th of 6 months supervised diet. I came so far to be denied . I have spent COUNTLESS hours doing resource and just day dreaming about it. It pretty much consumes my every spare moment ...lol !!

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rebelchelz    52

rebelchelz
Posted

Goodness that is quite the journey !! Well the very best of luck to you. I'm in my 4th of 6 months supervised diet. I came so far to be denied . I have spent COUNTLESS hours doing resource and just day dreaming about it. It pretty much consumes my every spare moment ...lol !!

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I know what you mean. It has been a crazy journey & praying I hear something soon. Please keep us posted on your story. I pray that it all goes well for you!!

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TJ1257    11

TJ1257
Posted

Aww well thank you so much and you as well ! My daughter and I are both in our 4th month. I think she will get approved no problems, 40 bmi with a cm. I really hope to go through it together as a family !

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QueenOfTheTamazons    634

QueenOfTheTamazons
Posted

Insurance does what it can to get out of paying. I started this process a year-and-a-half ago with a clinic in Chico. But that clinic had a $2,500 lifestyle management fee (total of $5000 for hubby and myself). I started the process anyway, hoping that we could find financing during that time. We weren't able to but I did find a doctor 3 hours away that accepted Medical and only had a $300 fee. That doctor said we could continue to do all of our preop with the doctor in Chico and we would switch prior to surgery. One problem, we were Anthem Blue Cross Medical and they only took pure medical because of issues with approvals. We were told that we could switch to pure medical close to the surgery date so that it would be paid for. Turns out if you've been Medical for more than 90 days they won't let you switch from Anthem Blue Cross to pure Medi-Cal. We fought to be switched for almost 3 months. During this time I was also trying to get my medical records released to the new surgeon and the old surgeon was doing everything they could not to. It took over half-a-dozen request and 2 months to get the medical records. After we figured out that there was no hope and switching to Pure medical my surgeon started working with Anthem Blue Cross to try to get me approved. They denied me right off the bat saying it was not medically necessary. What is complete bull considering I have a BMI 54 and 5 Comorbidities. Then they said that I hadn't completed the 6 months of a doctor supervised diet. I had done that with my primary care because the doctor in Chico was an 55 miles away. That dr allowed me to do those diet visits with my primary care. Apparently she had not been specific enough in her chart notes stating that we had talked about diet exercise and Portion Control in every appointment. Frustrated beyond all belief and in tears I force my way into talking to a supervisor in the approvals Department. I convinced them to let me submit a letter from my doctor saying that I had done all the requirements. That was also when I wrote my letter saying all of the family history the current issues ETC.

This was all in June. My health insurance was set to expire end of July so I was kind of freaking out because I didn't think I was going to get renewed with medical. They finally approved me August 5th , 5 days after my insurance expired , when I thought I had no more health insurance. I was finally able to reapply in September , only to find out that my health insurance was renewed in June and nobody bothered to tell me. So I could have had my surgery like 2 weeks after it was approved back in August which is frustrating. But at least I have my surgery date and it's in 4 days.

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QueenOfTheTamazons    634

QueenOfTheTamazons
Posted

Awesome thank you !! My email address is tabs1257@gmail.com

I really appreciate it.

I'm have spent so much money on different tests. My cholesterol levels are good and no sleep apnea. I'm just so worried because I don't have a severe comobibtity.

I have arthritis, degenerative disc disease ( had surgery to fuse my c5-c6-c7 in my neck ) severe Migraines due to that, dvt and varicose veins that requires vein stripping surgery....again ( Dr wrote in a recent statement that it is due to weight gain.) I had gallbladder surgery too.

My bmi is only 36

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Arthritis is considered a comorbidity. Do you experience folliclitis? Those painful pimple like sores that tend to happen where skin meets skin, under the breast and in skin folds? Thats considered a soft tissue infection and is a comorbidity. Even if your arthritis and ssti's are mild it might count. If you have ins and get folliculitis, go to the dr to get it treated (most people deal with it at home) so it can be in your chart. If you have any follicililitis scars, point them out to the dr to prove its an ongoing issue.

http://www.obesitycoverage.com/insurance-and-costs/pre-approval-process/comorbidities

http://emedicine.medscape.com/article/1830144-overview

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Alex Brecher    10,516

Alex Brecher
Posted

@@TJ1257,

I would try to check with your insurance company and get a definite answer. If you cannot get through directly, maybe you can ask a potential surgeon (or surgeon’s office) to check for you. You can get the answer in writing so that you can feel comfortable going ahead with it. If they are not going to approve you, you would probably want to know as soon as possible so you can start thinking about other options.

Good luck!

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mschan218    81

mschan218
Posted

Goodness that is quite the journey !! Well the very best of luck to you. I'm in my 4th of 6 months supervised diet. I came so far to be denied . I have spent COUNTLESS hours doing resource and just day dreaming about it. It pretty much consumes my every spare moment ...lol !!

Sent from my SM-N920V using the BariatricPal App

Me too...and im only in month 2!!

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Malin    470

Malin
Posted

I can COMPLETELY relate @TJ1257 This has been consuming my thoughts the past two weeks. I am like you, my BMI is 38. I do have diagnosed sleep apnea but it's not bad enough for my insurance AL BC/BS to cover it. I also have horrible cholesterol levels (I'm on meds for that) and osteoarthritis (under the care of a rheumatologist). My insurance will STILL not cover it. I guess I gotta gain weight to get this surgery covered. I am seriously considering self-pay...but wow it would be so much better if insurance would cover it.

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Kat36    7

Kat36
Posted

I can COMPLETELY relate@TJ1257 This has been consuming my thoughts the past two weeks. I am like you, my BMI is 38. I do have diagnosed sleep apnea but it's not bad enough for my insurance AL BC/BS to cover it. I also have horrible cholesterol levels (I'm on meds for that) and osteoarthritis (under the care of a rheumatologist). My insurance will STILL not cover it. I guess I gotta gain weight to get this surgery covered. I am seriously considering self-pay...but wow it would be so much better if insurance would cover it.

I was also denied my BMI is 36 and I have high blood pressure however BCBS feels it's controlled by best practice medical management. I'm appealing now. Did you ever get approved by your insurance?



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Kat36    7

Kat36
Posted

After three appeals the last appeal to UT office of employee benefits the BCBSTX decision was overturned! I'm approved. If you're denied but met the criteria appeal appeal appeal it's frustrating but don't give up. My surgeon's staff handled all my appeals because I should have never been denied anyway. On my way to a healthier me.

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Go To Topic Listing Insurance & Financing

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