12 replies to this topic

[JuliaW]

Hey! My insurance is saying I have been denied because they want three years of a bmi over 40 or 35-40 with a comorbidity. Problem is, I've been fat my whole life and have no comorbidities. The surgeon says they think the insurance csr doesn't know what she's talking about, but now I'm super bummed. Has anybody else sent pictures as proof? I have blue cross blue shield of Iowa!

[2Bme]

I haven't, but it couldn't hurt to send in pics.

I was talking with a gastric bypass lady a few days ago. We were both shopping for clothes at Good Will. She works for a major medical insurance and she said they been instructed to automatically deny approval the first time. It's wrong, but the number of people who appeal or try again is significantly less than the original requests. Is it possible your insurance does that?

[JuliaW]

Maybe! My surgeons office said they sent the paperwork on Tuesday and the insurance company said they denied me on Monday...but they wouldn't have had the paper work yet. The surgeon said to let them deal with it because they know all the ins and outs, so I'm hoping!

[sweetisme]

Julia-  This sounds way to familiar.... I have Blue Cross Blue Shield Alliance Select of IOWA and I was denied twice and the peer to peer with Dr. Glascock and the insurance company did not go well.  So........after all that, I decided to bring out the loaded guns. I submitted 20 photos (2 on each page) in chronological order from various times in my life...They all had something in common, I was obese each time. I've had short times of temporary success with lower weights (still NOWHERE near "normal".) I also made a chart that showed the last 20 years of weights and at the bottom of the page I highlighted the weights 117-140, which is my "normal" all my weights ranged from 196-298 lbs. Well above normal. So, all I can say if at first you don't succeed, try, try and try again. Perseverance pays off. They want you to get frustrated and quit pursuing it. If you really want it, fight for it. Stay positive, things will work out. We should stay in touch. I live in Cedar Rapids, but my husbands family is from Omaha!! To weird

[AliRn79]

sweetisme, on 09 February 2012 - 09:07 PM, said:

So, all I can say if at first you don't succeed, try, try and try again. Perseverance pays off. They want you to get frustrated and quit pursuing it. If you really want it, fight for it. Stay positive and things will work out

I completeely agree.  Definitely dont give up, appeal it

[AboutTime]

At 5' 6" and 272 your BMI is 43.9.  So if you have been that weight or not below 248 for the past 3 years you should qualify.  Don't you have any type of weigh in from a doctor.  Everytime I go to the doctor the first thing they do is weight, blood pressure, temp.  It should be in your records.

[JuliaW]

Sweet I know!!! I meant to email you back but I had to switch phOnes and stuff cause we had cox and they got rid of their cell service...anyway, I am exactly like you! I believe my weight in december of 2008 was exactly 248.  What about pregnancies? I was pregnant an gave birth in August of 08 and  and have birth in November of 2010. So they count pregnancy weight too? And I have zero co-morbidities but while pregnant had pre clampsia both times and gestational diabetes with my last. I'm so frustrated cause I had to wait a year to even do anything cause of nursing my son so  bummed that I have to wit even longer

[SillyCilli]

I really hope everything works out for you, I was just notified today that my letter was being sent in today so Im really praying that I get an approval Im so nervous, and so consumed by all this, but there's no way Im giving up and you shouldn't either  

[Looking2Lose]

I was denied the other day but because I switched who I was going to of through, insurance wise, then I am going to go and see if a different doctor can send my referral. My PCP is fab and is the one who suggested the surgery but because if I am with her then the insurance doesn't cover the surgery. So I switched so that I can get the surgery. I am praying this works out because if not I am going to flip on the doctor...all proof is there that I qualify, just send the doggone paperwork for referral!!! Good luck & keep us posted!

[SlimSmitty]

JuliaW, on 09 February 2012 - 03:21 PM, said:

My surgeons office said they sent the paperwork on Tuesday and the insurance company said they denied me on Monday...but they wouldn't have had the paper work yet.

hey hon, any updates!?!?

[JuliaW]

No updates yet! I got my appeal letter written and doing a sleep study on saturday! My pcp is pretty positive i have pickwickian syndrome which is a co morbidity for my insurance! If I dont come back with sleep apnea or pickwickian I am not sure they will approve me!  

[NEPoppy]

I know it is frustrating- so hang in there!! It has been 10 days since UNMC said they sent in my paperwork for approval and today I called my insurance company. They said they STILL haven't received it....After getting a green light, I have now hit a traffic jam. We will see what happens next week I guess.

[Looking2Lose]

Yeah I know what you mean the same thing has happened to me....its like you're so close yet so far away...Good luck and keep us posted!