BCBS University of Texas

Does anyone have this insurance and had a BMI 35-40 with a co-morbidity and still denied? I was denied because my BP is controlled by best practice medical management (a pill a day) so I'm trying to figure out how to get it approved since I don't feel taking a pill everyday is controlled.

My surgeon's office has asked me to go back to my PCP and have him say somewhere in my medical record that my BP is not controlled but I don't think that he will.

If your PCP won't, can you find a different PCP who will?

I may have to try. The problem is my BP is controlled by medication which is in their policy that is has to be uncontrolled and no one from BCBS can tell me what that means.

Uncontrolled would be taking the pills and still having high blood pressure.

I have appealed once and planning my second appeal now I'm afraid of being denied again and wanted to know if anyone else was denied and didn't mind sharing what it took to get BCBS's approval.

I have BSBSAL and I was denied last year because I didn't have a specific year of doctor's records. I do have high blood pressure and utilized a CPAP machine. I had to ask my PCP for a medical necessity letter and send in dated photos. The customer service reps were no help. They kept telling me to read the manuel which I downloaded and read repeatly. After about a month of receiving so respone, I started requesting live chats sessions which a person can print. My surgeon office even resent my paperwork. Finally, at the beginning of April, I requested another live chat and the rep said my appeal was in the correct department and they would send a letter. Last Thursday, I finally receive a called from the surgeon office saying I was approved. Since, I am a teacher, my surgery is scheduled for this June. My advice is to request a letter of medial necessity and ask the doctor to make sure that they state that the bp medicine is needed and without it, it could be a problem. Also, call and call and call.

I think I'm going to be denied too! But my BMI is above 40 with no comorbidity !? I have BCBS and they are dragging their feet... it's been almost two weeks, which is how long they said it would take and now when I call they are sayin SEVERAL WEEKS...ughhhh so I've been googling ways to get approved...so I feel your pain!! Keep us posted!

If my BMI was 40 under my plan I would've been approved. . I guess. I wouldn't be required to also have a comorbidity. Good luck to you.

I am waiting now for my approval with bobs blue preferred plan. I have a BMI of 40 with sleep apnea (cpap) and diabetes that is controlled with diet and exercise. We will see what they say. I was told that the diabetes doesn't help my chances at all but the sleep apnea does.

Are you in Texas? Both of those comorbidities are listed for my plan as well but being diagnosed and taking medication is not enough for them. Your BMI of 40 should be enough. Good luck.