Insurance denied...

So, I got the call today.  My insurance (Blue Cross Prudent Buyer) denied my RNY as not medically necessary.  My bmi is 39.7, and I don't yet have any documented co-morbidities.  If I had waited another week or two, I could have gained 5 more pounds and had a bmi of 40.  Insurance companies are ridiculous!  So, I'm waiting for my sleep study results.  If I have sleep apnea, the doctor's office will send an appeal with the sleep apnea as a co-morbidity, and then, maybe, I'll qualify.  The "date" was supposed to be March 10th, which is PERFECT for my schedule and would have allowed me to use spring break for my second week of recovery, but now I'm thinking I'll probably lose that date.  It really sucks.  I hope the sleep study results come back quickly.  I'm just so depressed about it!

Well that just sucks and i think that is ridiculous! Ummm I don't want to advise you to do this, but maybe you should gain the 5 pounds so you qualify with a BMI of 40 since it's already 39.7? I know that is terrible advice and I will probably get crap for suggesting that, but I am sure alot of people will think the same thing. It dosen't make any sense to me. It is true, about 5 more pounds would up that BMI to 40. I am so sorry.  Jaime

I thought about that, too, but I don't know if they will allow it or not.  I'm going to talk to the doctor's office insurance gal after school today.  There has to be something that will work.  This is crazy! 

Please keep us posted.  Hugs, Jaime

Keep your spirits up Michelle.  You are so close.  Oh, you don't have to gain the actual 5 lbs.  Just wear loose clothing and weigh yourself down with pebbles or a couple rolls of coin.  Be creative :-) Make sure you keep us updated, k? Hugs

Oh that blows! Insurance companies are so ridiculous! Really...less than half a point under the BMI requirement, it seems like such a stupid thing to be quibbly about! Like someone (Jillie?) mentioned, there are creative ways to have that scale tell you that you are over by that 5 pounds....lol.

Check with the ins coordinator on what you should do and keep us updated!


Shells