Is it possible to appeal?

Kiminey65
on 6/6/12 2:36 pm
RNY on 10/25/10 with
I am writing this in hopes someone can chime in with an idea or two,,,

I have a friend whose stats are similar to mine when I began my journey a year & 1/2 ago. I believe she is between 36-37 bmi, and was diagnosed with sleep apnea. Other than that, none of the other "biggies" applied. She was so grateful to have the apnea, so was just waiting on her date and the completion of hoops jumping...
Well, she texted me late last week that she was denied due to bc bs requiring 2 co-morbidities as of Feb 1st!!! She is so disappointed needless to say. I am too, as I have watched her weight fluctuate up and down over the years and all the struggles that go with that.
My question is, are there other ways to appeal the decision even knowing there is only one documented co-morbidity? Has anyone ever tried other angles? Like depression or maybe painful vericose veins? Just trying to help a friend out.....

                
MajorMom
on 6/6/12 7:05 pm - VA
Blue Cross is one of the most difficult but she really needs to get another documented to comorbidity to appease them. The ones to look for are diabetes or pre-diabetes, high blood pressure, high cholesterol, osteoarthritis, sleep apnea (check) and anything else she can find related to her weight or things that can be approved by weight loss. With Blue Cross, they may slip in a length of time over a certain BMI, so tell her to document her history well. Appeals are possible--how bad does she want WLS?  Also, let her know about good safe surgeons in Mex and Brazil. I have a couple of names if she wants to go that route and I'm sure others here have some names as well.

--gina

5'1" -- HW 195/SW 187/GW 115 July 08/CW 121 Dec 2012
                                 ******GOAL*******

Starting BMI between 35 and 40ish? 
Join us on the
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DS on Aug 9, 2007 with Dr. Hazem Elariny

paranoidmother21
on 6/6/12 11:06 pm - Lake Zurich, IL
I agree with everything Gina said - if you have their requirements nailed down, BCBS is very fast. But if you don't dot every i or cross every t, they just sit there.
Rebecca
Circumferential LBL, anchor TT, BL/BR, brachioplasty 12-16-10 Drs. Howard and Gutowski

Thigh lift 3-24-11, Drs. Howard and Gutowski again!
Height 5' 5".  Start point 254.  DH's goal: 154.  My guess: 144.  Insurance goal: 134.  Currently bouncing around 130-135.
      
Eliza55
on 6/7/12 1:03 am - PA

In addition to the previous comments, she might get a copy of the exact BC/BS policy on bariatric surgery.  That would inform her about exactly what the requirements are.  Then it's a check the box activity.

I was self-pay in the US, and found that when I asked my doc's group about costs, they had some pretty reasonable costs, so I was able to have the surgery at my local ABMS center of Excellence with all their support.  It worked well for me, and the costs weren't that much different, when I include all the labs and pre-evaluation studies, and post-surgical follow-up that was included in my surgery cost.

Eliza
Consult:239   SW:217  1mo:195  2mo:182  3mo:169   6mo:139  9mo GOAL CW: +2 from underweight
  
daydreamer27
on 8/2/12 4:54 am - LA

Good idea - exact copy of BC/BS FEDERAL WLS criteria - anyone out there have most recent? Sure would appreciate your sharing - shoot me a line or post here - Thanks so much and GOOD LUCK to your friend!

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