Denied (blue cross blue shield of alabama)

So, we went ahead and sent in everything to my insurance but they denied saying that I have not been morbidly obese for the past three years. Not sure why they say I haven't been, because my BMI has been above 40 since before April of 2012, so I'm not sure. Anyone else gotten denied? What did you guys do in these situations?

I would just really hate to have gone through all the work of doing the 6 month program with a nutritionist, paying out of pocket for all of my labs and what not. Truly upsetting.

Hi Jennifer,

WE are sorry to hear all you are going through with your insurance.  Here is a link to an appeal letter. Also, post this on our Insurance, Cash Pay and Financing and other members may have advice to help with the appeal process.

SAMPLE APPEAL LETTERS

Good Luck!

This happened to someone I know and once her PCP sent a letter verifying her weight history she was approved.  I hope this will work for you.

so sorry, I know how you feel, I was denied, too.

I took matters into my own hands and went to Mexico.  I am 9 weeks post - op.

Very glad I did.

You may have to think outside the box to make it happen for yourself! 

Good Luck on your journey! 

Hello Jennifer,

  Do you mind me asking if you had any other medical issues besides being overweight? I have my 1st meeting on May 11th and I am afraid that I may be told that I don't qualify ffor WLS. I have Sleep Apnea & Type 2 Diabetice. My BMI is around 39 my weight curently is 215 and I am 5' 2"

I don't really have any co-morbities. I have polycystic ovarian syndrome and have had high cholesterol and triglycerides for as long as i can remember. 

Talk to your surgeon's office. They should be able to fix this if you, in fact, have medical history showing your BMI has been over 40 for three years. 

Sounds like they may not have gotten all the paperwork. Find out what they need to get it approved. I was denied 3 times before I was finally approved and one of the times was because my weights were just submitted as a list of certain weights on certain days and what they wanted was the actual doctors notes from that day showing the weights. Once they got that it was fine and they ok'ed the surgery. They can be very nit picky! Good luck to you!

Jennifer, request or retrieve, from the insurance company website, a copy of the policy on Morbid Obesity surgery. You will find all the things required for them to approve your claim and sometime the doctors office does not know anything but what is told to them by a person at BCBS over the phone.

I know this because I am dealing with this BEFORE it becomes a denial rather than after. :0 I am preparing my own packet for filing and if they deny, I am heading to their offices to see someone in person to discuss the rationale.

Good luck to you!