Appeal for BC/BS PPO of MN to cover DS

Well, I called the insurance company today and the 46 page appeal packet I sent them for my DH is in their hands.  They have 30 days from yesterday to make a decision or request more information from us.

We sent in a seperate appeal packet from my husband to go along with the appeal packet the dr's office is sending in.   I included a long list of patients who've been approved for and had the DS surgery with our insurance, a copy of the 12 month medically supervised diet (which they swore was NOT included with the original request for surgery), medical papers citing the efficiency of the DS for diabetes, medicare's decision memo to cover the ds, etc. etc.

I feel really good about the letter and attachments that was sent -- it could not have been any better, the thing now is -- will they reverse the denial and approve this appeal??? who knows!!

The ins claims lady told his surgeon's office that they would have overlooked everything else and approved him for surgery the first time IF his bmi had been 40 for a two year duration, but since it was 37-39 for one of those two years, he wasn't qualifed.   They also quoted their own policy in their denial letter stating that they cover surgery for patient's with a bmi of 40>, BUT what they left out (and I was SURE to include the entire policy section in full as an attachment and quoted in the letter) the very next sentence in their policy clearly states that bmi's of 35-39 will be considered with co-morbidities such as hypertension, diabetes, etc. (both of which he has among many many others!).

I've crossed all the T's and dotted all the I's -- so why is my stomach in such knots??
I'm so worried they're going to deny him again.............he NEEDS this surgery even more than I did at 300lbs because of his declining health.....his diabetes etc just continues to get worse and worse.

Just venting and looking for prayers, thoughts, good wishes, lucky charms, swinging chickens, and anyother good luck vibes you can send our way!

I have BCBS of MN through my former employer & unfortunately all wls is included on the "general exclusion" list. I was reading an article earlier in the week from JAMA about wls curing diabetes. How long before this type of surgery is no longer subject to bias in the insurance industry? I'll keep my fingers crossed for your hubby...

Fortunately our insurace covers it if it's considered medically necessary.

I hate to hear your policy has an exclusion -- that just stinks!  Maybe one day these insurance companies will realize that it's in their best interest to pay for a surgery that will improve the health of their insured, thereby decreasing the costs they have to pay out for medications and doctors etc. It's insane!