Denial

Zaniiaim
on 1/18/12 3:43 am - CA
 Hi everyone!  I wa hoping this would be my week as everything was ready to go pending approval. Ny BMI is 38 with a comorbidity of high cholesteral.  My insurance, anthem BC of CA ppo, was supposedly one of the easier ones.   Well this morning I got a real shock because I was denied.  After calling all my contacts at the various offices they are assuming the high cholesterol isnt enough.  They now suggest a sleep study to add another comorbidity to my list.  Has anyone else been denied with Anthem for this reason? I'm just so ready, got all my vitamins thanks to this forum :) changed habits....I thought my insurance was a lock.  And what if I dont have sleep apnea?  I'm going crazy and would love to hear some other insurance nightmares.  Thank you and thanks for all the great info this site has provided over the last couple of months!

Aimee

poet_kelly
on 1/18/12 3:47 am - OH
You can always appeal and try to make a case for why the high cholesterol should be enough of a comorbidity.

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

wvugal89
on 1/18/12 3:52 am - MD
I have carefirst blue cross blue shield in maryland. My comorbidity was sleep apnea even though it fell into the mild category I was approved. Chances are you have sleep apnea the study can be set up quickly. High cholestorol was not an approved co morbidity for me.

Teri-Lynn
POI
     
H.A.L.A B.
on 1/18/12 4:11 am
BTW: my other comaorbility was accid reflex... I was not on ony medication but I was controlling that with my diet (i.e. no fried foods, no food 2-4 hrs before goingto bed, no pizza, etc>)

Hala. RNY 5/14/2008; Happy At Goal =HAG

"I can eat or do anything I want to - as long as I am willing to deal with the consequences"

"Failure is not falling down, It is not getting up once you fell... So pick yourself up, dust yourself off, and start all over again...."

Zaniiaim
on 1/18/12 5:44 am - CA
Thanks for the responses. From what insurance
Co. told me, their Dr. never noted my hyperlipidemia. My surgeon is going to do a peer to peer call and hopefully get the approval. Anyone have experience with this?

Thanks!
Aimee
mustangmama
on 1/18/12 6:59 am - TX
RNY on 01/03/12
BC/BS National PPO denied me for the lapband surgery in 2001 because the procedure was deemed experimental and my BMI was too low at 35 with only high blood pressure as my comorbidity.

I hired Kelly and Walter Lindstrom of obesitylaw.com to handle my appeal.  The appeal letter they wrote on my behalf was extremely well written and took into account a family history of heart disease (my mother had just died a couple of years earlier at the age of 57 because of heart diesease).

The insurance company reversed their decision and approved me for the procedure, so definitely appeal!!!

I highly recommend using Walter and Kelly to handle your appeal.  They're based in California, but handle cases throughout the US.  He's also had weightloss surgery, so he understands what you're going through and will be your greatest advocate dealing with insurance companies.

Good luck to you...
                
Zaniiaim
on 1/18/12 4:21 pm - CA
If no appeals work has anyone ever restarted the process at a
Later time? Especially with weight gain happening.
Most Active
What's on your Thursday Menu?
Queen JB · 50 replies · 503 views
What's on your Monday Menu?
Queen JB · 49 replies · 466 views
What's on your Wednesday Menu?
Queen JB · 49 replies · 406 views
What's on your Tuesday Menu?
Queen JB · 46 replies · 417 views
What?s on your Sunday menu?
Melody P. · 2 replies · 100 views
Forum Search Error & 404
RNY2007 · 2 replies · 62 views
What's on your Thursday Menu?
Queen JB · 0 replies · 3 views
Recent Topics
What's on your Thursday Menu?
Queen JB · 0 replies · 3 views
What's on your Wednesday Menu?
Queen JB · 49 replies · 406 views
Forum Search Error & 404
RNY2007 · 2 replies · 62 views
What's on your Tuesday Menu?
Queen JB · 46 replies · 417 views
What's on your Monday Menu?
Queen JB · 49 replies · 466 views
×