My paperwork was submitted December 21, 2016 for approval. Jan 3rd 2017 I called and found out I was denied, because I don't meet the New guidelines for 2017. I am really upset about it ????.

I don't think it's fair. Now I need 2yrs bmi >35 w co mobilities 40> w out co mobilities. 90 days NUT , psych eval. I have NUT class and psych eval but I need 1full year with BMI >40.

Has this ever happened to anyone.

Any advice would be appreciated.

Thanks

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That scares me to death! I have the same insurance. My last appointment is Monday.

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Don't worry about it everything going to be ok you will get approved. My situation is different I only have 1 yr bmi of 40 and I need two yrs.

Best of luck.

Wow.... how is everywhere so different?.

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I was approved by BCBS Fed in 2016. I was required to show 2 years of BMI history. I didn't think the policy changed at all from 2016 to 2017. If was submitted DEc. 21 - they should have processed it in 2016.

Well the doctor is going to do a peer to peer review , hopefully they will approve it. If they still denies it I have to make a decision pay for the sergury myself or wait 10 months to qualify. Any advice?

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Wow! I'm very ignorant about WLS approvals (though very familiar with dealing with health insurance for long-term disabilities) so forgive me for speculating but it seems strange they would hold an application submitted in 2016 to standards that were not in effect until 2017. Maybe they held onto it so they could deny it for that reason... or maybe I am just skeptical of insco's! I hope you get a good result from the P2P with your doctor.

Thank you .

Don't worry about it everything going to be ok you will get approved. My situation is different I only have 1 yr bmi of 40 and I need two yrs.

Best of luck.

Exactly why I just decided to book for Mexico. ugh!

What's the name of your doctor?

What about follow up after sergury?

I read that if have any comlacation the insurance company will not cover it.

I have fed BCBS also and was denied for the same reason so on to self pay it is

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I had my surgery two years ago now through Medica. I had to show a 2 year history with BMI over 35 w/comorbitities or 40 without.

Also I had to have 6 months of supervised diet.

These insurance companies are all so different. My insurance now covers absolutely nothing. In fact, my annual blood work wasn't covered because my PCP used the word bariatric in her coding. It cost me 2300.00

I had to go back to my bariatric center and ask for a letter showing medical necessity for annual metabolic nutritional panels. This happened in June and I had to pay it or they would send it to collections. So I paid it, and ever since I have been working on the appeal so I can get my money back.

you have to stay on top of them both before and even years after your surgery.

Maybe someday they will change all this so that they cover it on all insurance. (Yes I know I am dreaming)

This is a metabolic disease after all.

WOW! I guess I got lucky and was approved in September 2016 by BCBS FEP. Sorry that they denied you.

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You know, I just have to say this....I don't understand insurance companies. Doctors and insurance companies are so quick to say that our health problems are due to being overweight, but the insurance companies refuse to pay for anything weight related. Can't they see that if we weren't so overweight, that we wouldn't have as many health problems, thus they would save money?? I just can't understand how they haven't come to this conclusion yet. UGH!! I had to pay for my surgery out of pocket. They won't cover anything weight related at all. So ridiculous.

I also have FEP BCBS. I was sleeved on December 14 2016. I, too had to have all of the requirements you mentioned. I also know someone else who was sleeved earlier in the year with the same insurance, and he also had those requirements. I really hope the peer to peer helps you out! Good luck!

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