Jump to content
×
Are you looking for the BariatricPal Store? Go now!

My surgery application was denied by Fed BCBS.



Recommended Posts

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!

Sent from my SM-G920T using the BariatricPal App

Share this post


Link to post
Share on other sites

If you were seen even for an annual physical and were weighed then you can use that info to appeal.

Sent from my iPad using the BariatricPal App

Share this post


Link to post
Share on other sites

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.

36% of Americans are obese. I think they worry it would bankrupt them if they made it easy for 116+ million people to have a $20,000 operation. Given that that equals 2 trillion 320 billion dollars, I get why they want to make it hard to get approved.

Sent from my iPhone using the BariatricPal App

Share this post


Link to post
Share on other sites

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.

36% of Americans are obese. I think they worry it would bankrupt them if they made it easy for 116+ million people to have a $20,000 operation. Given that that equals 2 trillion 320 billion dollars, I get why they want to make it hard to get approved.

Sent from my iPhone using the BariatricPal App

I don't think that every obese person would opt to have surgery, but I do still think they should pay for weight related issues. My surgery didn't cost $20k, closer to $8k. Weight related issues cause insurance companies to spend a ton of money, so I do still think they should pay for weight loss help. I believe it would save money in the long run due to the amount of money that is spent on weight related issues such as sleep apnea, diabetes, etc, etc. I certainly agree with them having an approval process, but there are some that just downright refuse to pay for anything weight related at all, like my insurance company. Mine does not pay for it at all, appeal or not. It is outlined in our insurance so it doesn't matter what problems you may have. So I didn't have a chance unfortunately. I am not trying to start an argument, its just my opinion. Thanks!

Edited by ready_to_be_thin

Share this post


Link to post
Share on other sites

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

Sent from my SM-J700T using the BariatricPal App

Paying out of pocket....Cigna Insurance does not pay.

????sonkat5355????

Share this post


Link to post
Share on other sites

It's 11200$ for the sleeve package you stay one night in the hospital too not just an outpatient procedure ! Still nervous though

Sent from my iPhone using the BariatricPal App

Wow that's awesome.

Dr Umbach charges 10,400 cash for outpatient clinic.

Don't worry you Will be fine. I'm sending prayers your way and good vibes . ???? also I don't if you've heard. There's a wonderful support group on Facebook called . Gastric sleeve support group. Gastric sleeve worrier.

They both are closed groups Check them out there is 62k members a lot of veterans and newbies . Best of luck with your sergury.

Keep me posted.

Sent from my SM-J700T using the BariatricPal App

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
      · 0 replies
      1. This update has no replies.
    • ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×