Gaining Weight to Qualify for Surgery/Insurance Approval
on 11/7/13 3:39 am
Just the nuts and bolts:
Consulted with a surgeon about having DS on September 18th.
BMI that day was 49.4.
BCBS says BMI > 50 is required to cover DS surgery.
Claim for DS was submitted to insurance company (BCBS) in October. Surgeon thought with my comorbities that they would approve it; they didn't. Got the denial letter on 10/31, it says my BMI wasn't high enough.
Went to the surgeon's office for an updated weight yesterday, and my BMI is currently 50.8.
I'm not sure what to do with that information. Do I just include it in my appeal letter to BCBS?
Or should the surgeon's office resubmit with this new information? The coordinator at the surgeon's office asked me what she should do, and I don't know what to tell her.
I definitely don't want to screw this up! Has anyone been in this situation?