What now after denial of insurance?

I was officially denied today for surgery. My Bmi is 39.1 and I have had high blood pressure(documented since 2004 with meds) and also bad knees and bad back. I have been in rehab for both of them twice.I have BCBSNC. I got my hopes up so high, esspecially learning about everyone's approval's.( Which I am honestly happy for each one of them) But where do I go from here. I talked with the nurse that reviewed my case for BCBSNC and she told me that if I had waited until Monday July 14 that my insurance would have approved. I checked a BMI cjart and found that if I gain just 5 pounds that my BMI would be 40. Should I gain the 5 pounds? I hate all this waiting. Does anyone know any other treats to get insurance to approve?

Gain the weight then resubmit!  It is worth it!  My BMI was around 39.3  when I started going thru the process of getting approved and was told I might not get approved due to the fact my BMI was not 40 or more.  I made sure it was 40 or more by the time I saw my surgeon for my last appointment before the paper work was submitted to insur.  It is a shame to miss out on such a wonderful thing due to a few pounds! Andrea

I know we've been PM'ing eachother, but I just wanted to say how sorry I am this has happend.  It could easily happen to me next week...I hope they will resubmit next week and you'll see that approval....I'll say a prayer for you tonight!!! 

I would get with Dr. P and ask him what to do............ he will help you and guide you............ Don't give up hope.......... not yet........................... I know that's easy for me to say I have already been approved and had the surgery.............. Please don't give up until you talk to Dr. P..............I have alot of faith in him. After all I did put my life in his hands.......

I'd ask them to re-submit, but I would ask them to re-measure your height.  When I first went to them, the nurse haphazardly measured me and I knew it was wrong.......I told Dr. Bauman and he re-measured me himself and he was able to find an extra inch shorter than what the nurse did.  Untill you go back and ask to be re-measured,,,,,,don't go on any diets! I was borderline and made sure that I was over 40 before they submitted. Don't give up....chin up and try again!  Best wishes! Nancy

I do plan to talk to the Dr. and  the insurance team at the office. Thanks for advice, you seem so happy & bubbly. So positive, I could learn alot from your outlook on things. I'll let u know when I find out someone. Thanks again

I'm so sorry to hear of your denial. I'd want clarification about why you would have been approved if it had been submitted on July 14th. What would be different then, than it is now? Find out why you don't meet criteria now. Then, I would talk with the insurance specialist about the denial. While some are approved the first time, many are denied and have to go through the appeals process. Don't think that this means you aren't going to have the surgery; you just may have to do some more work before you get an approval.

Hang in there and continue to fight.

Wishing you all the best,

Barb

Thanks for the reply. I will wait until I get the letter of explanation. I don't plan to giveup, I will keep trying until I get an approval.I'll let you know when I find out more.

I was wondering what does Monday July 14th have to do with anything? And if you would have been approved on the 14th then if you appeal....You should be approved?! Something to look into....

Thanks for the reply,you can read my blogs on my profile page and it will tell you more but in short when I called and talked to the nurse that was working on my case for BCBSNC she told me that if my Dr. was a center of excellance physician that most of the time they are automaticly approved, well my Dr. will become a center of excellance physician on Monday July 14, that's why I was asking if I could resubmit or if I have to go through the appeal process.