I was denied by Tri-West

Okay so, I haven't received my denial letter yet so I don't know the reason for their decision.  I am 5'1.5" and I was at 190 when submitted to the insurance co. My doc submitted that my comorbidities are: Diabetes Miletus, Sleep Apnea, Morbid Obesity, Asthma and Hyperlipidemia.  I am 35 and have been struggeling with my weight since I turned 24.  I also have PMDD (a severe form of PMS only for me it happens at ovulation and I'm a total lunatic that time of the month...grrr)  My PCM stated in my letter of clearance that weight loss would also help with this condition since fat stores so many hormones it causes this to be much worse and I would benefit from substanial weight loss.  I can only guess that the reason for denial is that I am not 100lbs over my "ideal" weight however I know of several people that have been approved with the same insurance (Tri-West Prime) and have had lower than 100 to lose with only 1 or 2 comorbs.  Any suggestions on how to appeal???

I'm getting ready to be in your shoes, but my comments for now are: your BMI is very close to the minimum for insurance approval overall. Over 40 is the standard and 35 to 40 is considered with sleep apnea, diabetes, and heart associated disease. You have this, but your BMI is on the very low end, which may be why they declined it.  I haven't appealed, althought I think I will, but I would act quickly if I were you. I think you have 10 days to convey your immediate dissent befor you have to go through lengthier processes. In any case, you have a case, so don't give up!

I think your suggestion is helpful and I also liked so much. Thanks a lot!!!!!!!!!

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I received my letter of denial today and its because I'm not 100 lbs overweight....OMG  Hey gotta run to the kitchen and eat everything in site...............  LOL  How ridiculous...I know so many people with the exact same insurance coverage that got approved with less than 100 to lose and less comorbidities than I.  Grrrrrrrrr...It says I have 90 days to appeal on the letter, but I'll have it in soon!!!

I know! Rediculous. If it comes down to me gaining 10 lbs in one month to resubmit you can find me at the oreo cookies! Anyway, maybe you need to jump through more of the hoops to prove you are serious aobut this. Make sure your PCP and/or surgeon are intending to fight for you- and act fast! Good luck and keep us updated.