D*E*N*I*E*D (x-post)

Well, received the word today about my official denial- apparently BCBS of MN & their preauth review board didn't even bother to read all of the information my surgeon, etc included.  As soon as they read my BMI of 43.1 they immediately denied me as they consider the DS to "not be medically necissary unless I have a BMI greater than 50 with significant co-morbidities".  My surgeon is going to do an immediate peer-to-peer with the medical director as soon as they get their letter & I hope that works..!!  In the meantime, I'm gathering what studies I can to go forward with the appeals..  Here's an excellent one I found today:

http://www.springerlink.com/content/u11438757w123722/fulltex t.pdf

If I was the cursing type I'd probably be doing so right now, but instead I'm just holding on to hope & will keep pressing forward!! Any ideas, suggestions or information anyone may feel they can add would be much appreciated!! Thank you guys & here's hoping!!
Tallia C.

PS- Again, I have BCBS of MN /Bluelink TPA  "self managed"  (?) whatever that means..

Tallia - well, it's pretty much a guarantee with BCBS that the first time you submit for DS approval, you'll be denied, especially if your BMI is under 50 at this point. I think you knew that. But, having been in your shoes, I remember that even though I knew that was the case when I submitted, that getting the official "denied" stamp was still heartbreaking. So, I'm sending you a hug because I know how it feels!

Is Tammy & Metro Law helping you with your appeal? If they are, Tammy already has all the studies to attach and she also includes a list of patients who've had the DS with BMI's less than 50. That list is critical! There's a lot of names on there. If they are not, let me know. I have all my appeal documents in electronic format and could help you out if needed.

Did BCBS assign you a liason yet? If not, wait a few days or so and find out who it is. They should send you a formal letter concerning this, but it may take a week or so to get it. That person will be helpful as you'll call him or her to find out how your appeal is being handled, etc. I called my liason every day during the appeal process so that she got to know me. I figured it couldn't hurt. In the end, she called and said "they were going to deny you again but I told them they had to at least review all the new info you sent us with the second appeal before I'd send out a letter". She helped me, the insured, when she wouldn't have had to. I feel it was because of those daily check in calls.

Keep your chin up. Your fight is just beginning to be honest. But, it will be worth it when the approval comes!!!

I hope it all works out!!! I'm sorry to hear about the denial... but of course Amy has proven that it can be done! Good luck to you!

Thanks guys! I really appreciate the encouragement :[)

That sucks! I bet you're so disappointed!  I hope your surgeon can advocate for you to get BCBS to approve you.

I'm curious why with the DS, does insurance want a BMI of 50 w/ co-morbidities?  What's the rationale there?

To be honest with you, I really couldn't give a straightforward answer to that... To me it doesn't make much sense at all- besides, shouldn't it be the SURGEON & DOCTORS who choose the best procedure for you since theyre the ones with the expertise & knowledge of your particular case?? Why should someone who's sitting behind a computer desk look @ your BMI & not even look at another shred of paper then say the procedure is "Not medically necissary"??  I haven't a clue sweetie! I'm sorry!!