Appealing to Insurance Company for Coverage

I --- almost, not quite --- meet the BCBS of Michigan guidelines for RNY surgery coverage. I'm wondering if anyone has made a successful appeal to the company for coverage. I'm looking for arguments to make that might be persuasive.

I am trying to put dollar figures on my continued health care if I don't have the surgery.

I am also a cancer survivor and trying to make the argument that the risk and re-occurrence of cancer are as life-threatening as heart and diabetes issues.

Any other ideas or successful arguments?

thanks,
d

 Where are you falling short in their requirements?

Only 1 co-morbidity - arthritis, a BMI of 38 and not 100 pounds over weight.
d

I wonder if it's just your policy.  I thought my policy only required one co-morbidity if BMI is under 40.  Thankfully my BMI is just over, 41.7.

Hi Frances,
I'm going to the same place you went to. It is 2 co-morbidities for a BMI under 40, ah well. I'm going to try to persuade BCBS that I'm soooooooooooooooooo close. :-) We'll see.
thanks,
d

If you don't meet the criteria, no amount of fighting will help until you do meet their requirements.  So which thing are you not meeting?  Maybe we can help you figure out how to get it done...

I'm not 100 pounds overweight, I have a BMI of 38 and only one co-morbidity --- arthritis. I had uteran cancer last year and want to make a case for the increased risk of re-occurrence as well as cancer being as life threatening as heart disease or diabetes.
thanks,
d

Have you been checked for sleep apnea? Also do you have lower leg swelling since your cance? I thought I was just over wt. and went to get liposuction  on my knees and was diagnoised with lymphedema. Insurance approved RNY within 2 weeks  of submitting. I also have heart conditon ,osteoarthritis,hypertension and sleep apnea.and BMI 48.Good Luck!