Insurance Denied Surgery

I just found out that my insurance has denied the request for surgery. So--I am on 7 shots of insulin a day--have sleep apnea--enlarged liver--family history of heart issues. If I weighed 10 pounds more I would be over the 40 bmi. I have not lost or gained in the last 6 months. They said that the surgery is not medically necessary--say what??
gRRRRRRR!!!!!
Sharin

What insurance do you have and what procedure are you asking for coverage?

You can appeal the decision!!  Your surgeon's office should be able to help you with the process.  You can get letters from multiple docs and more medical history to submit.

Good luck!

Reenie

Don't give up!!!  I had the same thing happen!  You can get approved, esp with your comorbidities. 

I have Blue Cross Blue Shield of Mn. I am trying to get a RNY.

I just wanted you to know that I had BC/BS in '06 and was able to get approved on my first time through.  I know at the time I had my surgery one requirement for approval was a year supervised diet with a doctor.  By chance I had done this ahead of time not knowing it was a requirement.  Have you checked the BC/BS website to see what all the requirements are for approval?  Maybe you just need to make sure you have met the requirements.  If you have then APPEAL...APPEAL...APPEAL.  If you have not met their requirmenets then start on that right away.  Hooe this helps some.  But for sure hang in there, be strong and don;t take NO for an answer.

Linda

Have your surgeons office, your PCP, and your Endo all write letters on your behalf and submit them with an appeal to BCBS!

My other suggestion is that if that does not convince them, have your surgeon ask for a Peer to Peer with them (usually just a phone call) and ask them to consider a re-weigh. This happened for a fellow board member and on that alone, she won her appeal.

You have MANY options yet so please do not think this is the end all be all!!!

I agree - keep trying~  I was told the 40 bmi was a baseline and if there were other comorbid conditions, it could be lower than that!  Good luck!

Therese

I'm sorry to hear you were denied.  Was the reason due to your BMI?  Did you meet their requirements as far as the 6 months medically supervised weight loss attempt?  I had BCBS and had to do that, what a pain!  I hope with a few things Amy mentioned, they will change their mind. I thought with comorbidities, the BMI could be lower.  Don't give up!

Sharin...keep fighting....you will get your surgery. They are just trying to see if you want it bad enough to fight for it. I had many hurdles but never gave up. You can do it!!!

Talk to anyone who will listen....get letters from everyone.

Hugs....connie d