Let's start off by saying that I am so disappointed today .  I get a letter from the Insurance company stating that..." A PHYSICIAN ADVISOR HAS REVIEWED THE INFORMATION PROVIDED AND DETERMINED THAT THE REQUESTED SERVICE WOULD "NOT' BE COVERED AS MEDICALLY NECESSARY."
How can this be????  I did EVERYTHING my surgeons office asked of me. 
Consultation...Nutritional Eval...Psych Eval...Pre Op class 4 hours...Lose 8 lbs...to get my bmi to 55....pcp referral letters.....WHAT DID I DO WRONG?

I have BCBS CA PPO and I need help.  This letter is stating that the documentation does NOT state how I tried and failed my MANY MANY years of failed attempts, and diets tried...WTH!!  I am 40 years old and being over 300+ lbs...do you NOT think I tried..

Both Surgeon's office and Primary Doctor HAS all my attempts since i was 15 yrs old.  WOW!!!

Please just anyone that has any ideas, please send anything to me, thanku :(

 I am so sorry. Could you call them and make sure they got all the correct paper work? I hope someone here can help you with this.

I know it's disappointing but many times I have heard about this happening and it turns out to be something minor that was overlooked. Have you called the surgeon's office yet? Talk to the insurance coordinator and find out what you can do. You may need to call the insurance office and find out what they need or what you need to do to appeal.
I am hoping that it is something that can be taken care of pretty quickly.

I talked to the Insurance coordinator and she mentioned to me that she will have to contact my insurance and ask what exactly they need.  She said she submitted ALL paperwork and she IS NOT sure what they are asking..BUT..then again she told me this last week and when she pulled open my folder today, there was NOT one thing done. I will have to contact the Insurance company and ask them why.  I want to understand their process and why they do not have documentation.  IM CONFUSED.. I will call tomorrow..

I tried all of this back in 2003 in WA State just to find out i was denied for RNY but then again that was another insurance, ...Im just overwhelmed.

Thank you for your support and to all that have suggested ideas for me.

Since this is your surgery and your journey, I would not wait for the insurance coordinator to get off her backside.  You need to pick up the ball on this.

Begin by calling your insurance company, have a pen and paper in hand, and find out EXACTLY why you were denied, EXACTLY what they need, where do you mail your letter of appeal, and to whose attention should you mail it to.  Be sure to write down the name and number of the person you spoke to and ask for a reference number of your call to them. 

I would go to your physicians office and get a copy of all your records.  If you have any records at any weight loss venue, gather those as well.  Any place you have gone to try and lose weight, get the records. 

Make sure you have everything the insurance carrier is demanding, and then write the appeal and provide all documentation.  Also be sure to keep a copy of everything for your records because insurance companies are notorious for losing records.

In your appeal letter, be absolutely sure to keep the need for surgery to strictly medical reasons why you require the surgery.  Do not put things in like you cannot play with your kids because you're too heavy as, believe it or not, this could be viewed as a reason for denial.
 
The insurance company has been known to view statements such as that as the reason you are actually wanting the surgery, and since they do not care that you cannot play with your kids, surgery is denied.

I do this sort of thing for a living, so if you would like, get your letter written and send me a copy of it and I'll go over it for you.

Wishing you much success in your endeavors!!! 

I have an Anthem Blue Cross CA PPO Individual policy and got approved on my first attempt. In fact, a BMI over 40 is practically a guarantee of approval.

I have to believe something was submitted wrong.

Kim, WHAT!?? That is outragoeus. We have the same Insurance too. remember I told u that over the phone. My goodness, go to Dr Coirin! Sherry there is a really good Insurance Specialist. People like me who get approved, have complications and are now getting a damn reversal (emergency) get approved, but someone *****ally should get approved DONT! Tell me how odd that is? Call or text me..Im sorry to hear this!

Hey Kim I'm sorry to hear about this! I dont understand why your insrance co denied you for surgery??? I hope you will get this  matter resolved very soon. Keep us posted
((Hugs))