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BMI 39-bcbs of north carolina

Cloteal

By Cloteal, in LAP-BAND Surgery Forums

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stajin22    0

stajin22
Posted

I have not heard anything else so no news is good news.

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stajin22    0

stajin22
Posted

Great News!!!!!! I am approved, Aug 13th is the day for me and my first part is over. Now I am going to work on being healthy forever.

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Cloteal    0

Cloteal
Posted

Great News!!!!!! I am approved, Aug 13th is the day for me and my first part is over. Now I am going to work on being healthy forever.

YES!!!!!!!!!!!!! Congrats to you. I am so excited for you, hopefully we can Celebrate together. Pray that mine get approved to.

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stajin22    0

stajin22
Posted

I will just stay positive. I go for my post op appointment on the 10th. Shoot me an email I will send information to you.

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Cloteal    0

Cloteal
Posted

Ok you guys, I received a call today from my surgeons office stating that the insurance company need more info before they can approve my surgery. My surgery date was set for 08/13, now that'll probably change. The insurance co is requesting more info from my primary physician, well that info is a 5 year weight history, and a referral letter, I provided all that info to my surgeon, why is my insurance co still requesting that info. I'm wondering if the surgeons office didn't send all my paperwork in. I'm very frustrated and now concerned that I may not get approved. I met the qualifications, I thought, my surgeon said it shouldn't be a problem getting an approval. Then what is the problem! Thanks for listening, just needed to vent.

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Cloteal    0

Cloteal
Posted

Update. Received another call this evening from my surgeons office, yes BCBS requires additional info on my blood pressure and acid reflux. My primary care provide don't have anything else, I wasn't on any meds as we figured if I get this surgery then my blood pressure would go down. Besides I was only borderline hypertension that could be controlled with eating right and losing weight. Just the past month or so it got really out of control, I didn't go to my Doctor as I didn't want to go on meds (dumb me), but I felt I had a good chance of getting approved. I don't know now what to do. Can anyone help.

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skep    9

skep
Posted

Update. Received another call this evening from my surgeons office, yes BCBS requires additional info on my blood pressure and acid reflux. My primary care provide don't have anything else, I wasn't on any meds as we figured if I get this surgery then my blood pressure would go down. Besides I was only borderline hypertension that could be controlled with eating right and losing weight. Just the past month or so it got really out of control, I didn't go to my Doctor as I didn't want to go on meds (dumb me), but I felt I had a good chance of getting approved. I don't know now what to do. Can anyone help.

Interesting. I wonder if a trip to your primary and a medication for HBP would do the trick. Have the criteria changed? I know that I was a tad below 40 with no comormidities and was approved. Or maybe the blood pressure readings? I don't think it will delay your surgery. Just attention to details. But then I'm not an insurance person. Does the insurance specialist have any suggestions? Or your doctor?

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Cloteal    0

Cloteal
Posted

Interesting. I wonder if a trip to your primary and a medication for HBP would do the trick. Have the criteria changed? I know that I was a tad below 40 with no comormidities and was approved. Or maybe the blood pressure readings? I don't think it will delay your surgery. Just attention to details. But then I'm not an insurance person. Does the insurance specialist have any suggestions? Or your doctor?

No, they didn't give me any suggestions just to revisit with my PCP. I will call Monday to get an appt with my PCP and hopefully she will put me on BP meds. I had my BP checked today at the Drug store and yes, it is still high. I know they say the normal reading for High Hypertension is 140/90. My BP read today 147/95, this is low compared to what is't been. It usually run around 165/106, somewhere around that. Hopefully this will work, just pray for me. How are you doing?

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Tory09    1

Tory09
Posted

Stajin, That is great news! I am so happy for you... I feel like you were feeling ... excited to get all these preliminary tests over with. I have a sleep study on Monday night to do and then the nutritionist appt on Friday... after that the paperwork will be sent into the insurance company. Keep your fingers crossed for me... I am so excited but nervous at the same time. Good luck to you! Keep us posted.

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Cloteal    0

Cloteal
Posted

Ok you guys here is another update, I went to my PCP today to get the additional info that they (the insurance co) requested. My blood pressure was up, they had to put me on BP meds (a plus for me). Now don't get me wrong, I don't won't high blood pressure, but if this is what's going to help me get approved. The acid refux yall is a very terrible feeling, they put me on meds for that as well. My PCP said she will write a letter regarding these issues, and will put on there that this is do to weight gain. Yall pray for me that this will help me get approved. I'll keep you all updated. So far as I know my dates have not changed for surgery, which is 08/13.

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Tory09    1

Tory09
Posted

I will pray for you to get approval. Please do the same for me... I am so scared of this process but anxiously hoping to get the surgery...

Keep us posted!

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Cloteal    0

Cloteal
Posted (edited)

Thank all of you that prayed for me and who were just as anxious as I was, but no, I was DENIED! The reasons they gave was a bunch of mess. My BMI was a 40.6, for the past 4 out of 5 years it was a 40, besides now I have high blood pressure which I am now taking meds for, along with acid reflux. Don't know what happened. I called the insurance co to see why they denied my approval they said, because my BMI was below 40 with no comorbidities. Come on the paperwork is right in front of you, I had 2 doctor letters of recommendations stating all these facts, the letter from the surgeon stating that my bmi at that time was a 40.6 and that my blood pressure was high then too. The insurance co also stated that no psych eval was done, no nutrionist eval was completed, which is all false. I was in the surgeons office on yesterday for my group eval, when I was given this news. The clerk there showed me my packet everything that was sent to the insurance co. Nothing in that packet showed my bmi below a 40, the letters from my PCP was there, the psych eval was there, the nutritionist eval was there, WHAT WAS THE INSURANCE CO LOOKING AT? Well, they told me that they were going to do a (PCR) patient courtesy review. I should hear something Monday. I told the insurance co, someone is either falsifying info on my paper or someone is not doing the review. Based on the BCBS policy I meet all requirements. I don't know what else to do. Guess I will be appealling.

Edited by Cloteal

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Tory09    1

Tory09
Posted

I am sure you will be approved... cause if they said you didnt do the nutritionist or psych eval - then you would have def been denied... I am praying for you!!!!!!!!!

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Cloteal    0

Cloteal
Posted

I am sure you will be approved... cause if they said you didnt do the nutritionist or psych eval - then you would have def been denied... I am praying for you!!!!!!!!!

Thank you for your prayers. I will be praying for you to.

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Cloteal    0

Cloteal
Posted

For those that care and those that don't, I can finally can leave you alone, I know I probably was worsen, but I'M APPROVED!!!!!!!!!!!!!! Thank all that prayed and was concerned. My surgery date is still scheduled for tomorrow. I will keep you posted.

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Go To Topic Listing LAP-BAND Surgery Forums

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