Denied by BC/BS Texas

[GTGirl 3]

I have meet all requirements for the bypass surgery however BC requires a diagnosis code of Morbidly obese even though I dont fall under that based on my BMI. I fall in the Obese with a co morbidity. Anyone else have this problem and what diagnosis code did you use. So frustrated. Its been a year. Ive done all the preliminary work I just need the approval for the surgery. So ready to move forward.

[Briswife15 889]

I have BC, and needed Either a diagnosis of Morbid Obesity OR obesity with 2 co morbidities, such as Diabetes and severe sleep apnea. Without those 2 co-morbities they won't approve you at a low BMI. I'm sorry you're going thru this. I know it is really discouraging.

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[ahillig 136]

I have BCBS federal and they say BMI of 40 with no comorbidities or a BMI of 35 with one or more comorbidities. I do have arthritis diagnosed in my knee so that counts but it's stories like this that make me weary of letting my BMI drop below 40, I'm sitting at 42 right now so I feel like I'm teetering. Hopefully you'll get it sorted out soon and get approved!

[GTGirl 3]

I will let you know as soon as I hear something. My daughter may have stumbled upon the correct code. I've asked my Dr. to resubmit with that code. Please say a prayer that its the right one and I will pass it along as it may help the next person. Thanks so much for responding.

[KimB7811 115]

23 hours ago, ahillig said:

I have BCBS federal and they say BMI of 40 with no comorbidities or a BMI of 35 with one or more comorbidities. I do have arthritis diagnosed in my knee so that counts but it's stories like this that make me weary of letting my BMI drop below 40, I'm sitting at 42 right now so I feel like I'm teetering. Hopefully you'll get it sorted out soon and get approved!

I have BC/BS Fep too. I’m really nervous for submission because of being on the low BMI side. Only 35.5/36. I have 2 co morbidities (Hypertension and Severe Osteoarthritis in my knee). My surgeon said he feels pretty confident I will have no issue with my insurance and those issues for approval but I’m doubtful. He said BC/BS is one of the better ones for approvals too. I’m sorry you got denied GTGirl. But fight the insurance on it. You’ll get it.