Denied 1st appeal started

 I can not believe it. BC/BS of NJ Horizon denied me. I have a BMI of 40. They said I did not have a BMI of 40 for the past five years. I explained to them that is because of failed diet attempts. I went to me primary just for sick visits and regular blood test. Last year my BMI was 40 and for the previous years it was between 37 and 38. They said it was not medically necessary. The only co morbidites I have are reflux, digenitive disk disease, and joint pain.  I don't know what to do now. I guess I just have to wait. Reading the board it look pretty bleak that it will be over turned.

I am having the same problem with denial by Horizon BC/BS of NJ. I have Reflux, HTN, sleep apnea, back pain, joint pain, and depression; my current BMI is >40; and I have been >35 BMI since I was 14 years old. About three years ago I TEMPORARILY lost some weight and got my BMI down to 30.7, but as usual I gained it all back and then some.  It is ridiculous that now Horizon can use this as the basis of their denial since I do not meet their "5 year rule".  I would have thought it gives more of a proof of failed diet attempts.  I am still trying to get the denial overturned, but yes it does look bleak from my end especially since I have clearance for surgery and really believed it would happen this summer.

I was denied for the second time. It is not going to happen for me. They will not approve me because of the 5 year BMI rule. I have started my diet plan once again .Hopefully this will work for me. I wish you luck and hope you get approved.