On the cusp - it could go either way!

A gallon of water weighs 7 pounds.  Insurance companies do not round up

Thanks everyone for the input!  By the time I reached out to my doctor's office, she had already submitted my paperwork for approval, so it is what it is now.  I would certainly hope if they are the experts, they would have recommended weighing again since I was so close, so I'm hoping they felt confident I'll get approved.  Stay tuned...I was told it can take up to 2 weeks.  Thanks again everyone! 

I will certainly keep a good thought for you. I, too, thought the doc's staff were experts, but the girl in the first office really had no clue. I ended up firing them and moving to a different doc because of the issues with the front office. Let us know how things go!

I received word today my claim was denied. 

• When I called BCBS, they said my BMI in 2010 and 2011 was below 35
• I need 3 cardiovascular reasons for surgery (If my BMI were 40, I wouldn't need additional 3 reasons)

My PCP entered my height at my word; and I was wrong.  My bariatric surgeon's office actually measured my height - a full inch shorter than my PCP has.  In short, my BMI was 35 those 2 years with the corrected height.  MY BMI is currently 40, but was submitted as 37.9 with my LOMN from 2 months ago. 

Hopefully we can resubmit with the corrected height, and my updated weight.  I'm not sure about the intricacies of all this, but I'm sure disappointed my surgeon's office wasn't more meticulous with the details.  She should have known as submitted my insurance company would never approve it. 

Thanks again for your input.  I'll keep you posted as this progresses. 

I am sorry that the poster's were right.  I have seen this happen too many times.  I hope your resubmission will be successful.  Truly.  

I'm not at all surprised, but I am sorry.  I wish you had come here and asked us before your surgeon submitted the request (especially since it is hard for me to feel optimistic about them allowing you to correct information so that you do meet the criteria (even if it is a legitimate correction)).  

Yes, your surgeon's office should have KNOWN you would get denied.

Please do let us know how your appeal turns out, though, because we really don't have a lot of people who get denied because they don't meet the criteria. It's usually just because some paperwork or information was missing.

Keeping my fingers crossed for you...

Lora