I did everything required by my fidelis medicaid. I fit into their requirements with my BMI. They are saying it's to low (35.7) for my height I'm still obese. Now I have been denied. The surgeon did a peer to peer and was denied. The head nurse had me file a complaint w the Attorney General and went for an appeal w their support and was denied again. Now I am going for an external appeal. I am very upset and disappointed. I do not know what to do.

Edited April 6, 20197 yr by Jennimomma201943
Clerical error

? Sorry, that sucks. Wish I knew how to help.

I am sorry to hear that you were denied. Did they say why? Your BMI seems to be on the lower side and from what I know you also have to have a related co-morbidities such as diabetes, high blood pressure and sleep apnea and a few other diseases.

Good luck on the appeal.

Edited April 6, 20197 yr by SusieQ2019

They said my bmi was on the low side but what I read it is in within their guidelines. I have high blood pressure and high cholesterol.

Just wanted to say I'm sorry you were denied. Hopefully the external review will reverse the decision.

Keep fighting. So,sorry

I’d say keep on fighting eventually I think they will give it to you. Because I’ve met some lady who I think was 200lb and she wasn’t short so her BMI was low. She said they denied her. But she kept on complaining putting in appeals to her insurance and finally the wa able to get the surgery. I was surprised she even said she didn’t have to do non of the requirements I had to do. But hey I guess if you bother your insurance long enough they will probably let you get surgery. Also she didn’t have diabetes or high blood pressure

Keep fighting don't let them win, do you have any other comorbidities????

If possible you can always self pay. They have facilities that will work with self pay as some people get denied or just don’t want to deal with insurance hassle.

Some places offer financial assistance which will help offset the cost for you. That's how I was able to do mine although approved by insurance my deductible was through the roof so if it wasn't for the FA support I would still be waiting. Don't know where u located but it won't hurt to ask. I wish you all the best don't give up.

I have been trying to find out how much it will cost if I self pay. Does anyone have any idea so I get a roundabout figure?

I’ve seen around $10,000 (but may not cover some pre testing), $15,000 - $20,000 that covers everything.

Mine was $19,000 (thank goodness for my wonderful insurance though)

About 23,000 but that includes pre-testing and visits

Ouch! Do u think they charge more to insurance companies?

Look at Blossom Bariatrics...the most you will pay is $15,500 but they will try to work with your insurance to take care of testing and stuff so your price could be less but that’s the max you will pay. This price includes hotel and transportation. They’re located in Las Vegas.