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Anyone have luck with peer review reversal?



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I was told this morning that I was denied because the co-morbidity I have isn't "severe enough". My BMI is 37, and I have sleep apnea. I also have Rheumatoid Arthritis and Fibromyalgia (Which I know they don't consider). I have been not been able to lose more than 20 pounds in over 20 years. I need to lose roughly 80lbs. There is a "peer review" today with my doctor and the insurance company. Has anyone had it overturned by this action? I'm devastated.

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sorry, I have no experience in this, but I would like to point out that your side profile shows that you are 217kg (478lbs). I'm assuming since you said your BMI is 37 that this was a typo?

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I cannot get the thing to change to lbs. I dont know why it says kgs!

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8 minutes ago, MandyLou said:

I cannot get the thing to change to lbs. I dont know why it says kgs!

Not sure if you are using the mobile app or the desktop version, but if you are on the Desktop:

  1. Click your profile pic at top right, select MY SURGERY from drop down.
  2. Select PROGRESS on the left side bar.
  3. There will be a toggle button that you can switch from metric to imperial measurements

2028563931_ScreenShot2021-09-15at1_20_57PM.thumb.png.ffcdee5ad2bb5157192d39916b4fa7ec.png 1537451391_ScreenShot2021-09-15at1_21_27PM.thumb.png.a6513c8d228114e0a8afcd9608ffc6f3.png

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Oh thank you!

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I have BCBS and the peer to peer didnt work and I am on my first appeal.

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I had peer review 2 days before surgery was due. It worked. The Tufts insurance doctor was a retired pediatrician and knew nothing about bariatric surgery. My surgeon is the head of bariatric surgery at Beth Isreal Deconess so he convinced him it was necessary. I think it may depend upon the “players” and situation involved. Keep your hopes up and fight for yourself. I talked to a bariatric therapist because it was pins and needles until 11 hours before surgery. I didn’t want to slide.

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Mine did not. I am putting in my first appeal.

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