RNY Gastric Bypass Investigational?????

I just received a denial from BCBSGA to cover my RNY gastric bypass.  They are saying the surgery is investigational???  Which is a total lie.  My doctor called the Director of BCBS and he told them to resubmit everything and appeal it.  Has anyone else had this trouble with BCBS of GA?

Hi.  I have BCBS and they approved me rather quickly for an RNY.  Do you have any triggers (high BMI, diabetes, etc. , are you considered obsese?)

Yes....I have a BMI of 54, which is morbidly obese.  I am Diabetic, have severe sleep apnea, high blood preasure, GERD and joint problems.  That is why I don't get this.  I thought it was a given that I would be approved the first go around.  I even called the insurance company before I started all of the this and asked what they specifically needed to cover my surgery.  They told my employer has included it in my policy as long as it is concidered Medically nessasary they will cover it.  I did everything they asked of me and then they turned me down. 

You need to call the insur co again.  Something is not right.  The only other thing I could think of is that they approve "centers of excellence" I think.  They only approve certain doctors and certain hopsitals.  Check surgeon and hospital.  Go to the BCBS Federal web site and look for Bariatric Surgery.  They have a whole section; have you seen it?  Don't let it go - keep calling them until you get the right person on the phone. 

Dr. Burrowes was my surgeon and I also had BCBSGA HMO at the time of surgery.  Did you submit a weight loss attempt history, nutrition and psych consult?  I had no issues at all with approval.

I just received my denial letter from BCBSGA last night.  It said that Dr. Burrowes requested a Long Limb Gastric Bypass.  I think that is the problem.  This is not a standard RNY gastric bypass.  I trust Dr. Burrowes, so if he thinks that is what I need than I am all for it.  Katherine seems to think that since he called the Director of BCBS and spoke with them on my behalf that I will be approved with the appeal.  Atleast it makes a little more since to me now why they denied me.

You will probably get the approval.  Dr. Burrowes is very knowledgable and if he is going with a different variation (Long Limb vs. Standard RNY), you can be sure there is a good reason.  If he spoke to the Director and explained the decision, I think BCBS would have a hard time disputing it.  As long as your employer has purchased the applicable riders, there is really no reason to deny your request.