Denied Officially Today - (1st Round)

Divine_Ambrosia
on 9/26/11 7:52 am - Cary, NC
 So I was denied for the 1st time today from my insurance, of course, we all saw it coming.

"The request does not meet the definition of Medical Necessity found in the members's benefit booklet.
It is not deteremined to be medically neccesary because criteria and guidleines in the policy are not met."

My BMI is 43 , not 50.

-sigh- 

I was so hoping.  So here's hoping to going forward.

Ashia
MajorMom
on 9/26/11 7:57 am - VA
Blue Cross Blue Shield, right? I hate them!  

Good luck on the second round.

--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
Lightweights Board!
DS on Aug 9, 2007 with Dr. Hazem Elariny

Lori F.
on 9/26/11 7:58 am - Chula Vista, CA
Ashia- Don't give up! C'mon! Are you sure the BMI thing is the only reason. I'm asking because they didn't specifically say it was the BMI only. What are the other requirements and have you met them? You have to know all of this. We can try to help if you post everything.
Pre-band highest weight: 244
Pre-band surgery weight: 233
Lowest: 199 ( for, like, a day)
CW:
260 (yes, with the band!) 
Current Fill: 5cc in 10cc band
BMI: 49
Divine_Ambrosia
on 9/26/11 8:06 am - Cary, NC
I've met all the other requirements.  I've already been approved for RNY or Vertical sleeve and have surgery scheduled, however I wanted to change surgeons and to DS so we started over again.


Lori F.
on 9/27/11 3:45 am - Chula Vista, CA
Aarrgghh! Good luck, then! Don't give up. I just sent my appeal to the state yesterday. I am freaking out....
Pre-band highest weight: 244
Pre-band surgery weight: 233
Lowest: 199 ( for, like, a day)
CW:
260 (yes, with the band!) 
Current Fill: 5cc in 10cc band
BMI: 49
Imissthe80s
on 9/26/11 8:12 am - Louisville, KY
DS on 02/27/12
My BMI is 42 and even with knowing that, the "No" would definitely make me flinch for a second, but you have to ask yourself, is it worth another "No" or even 2 more "No's" for a possible "Yes" thrown in just when you were about to give up?


divakay2
on 9/26/11 9:26 am
Don't give keep pushing for that DS...........................Kenya
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