Reposted right group- need Advice

A little about my health...

I'm 5'7, 250, mild sleep apnea, high cholesterol.

I'm 110 lbs overweight, and my BMI is 39.1

I'm with TriWest, they approved everything BUT denied my surgery. I called TriWest to see what the deal was and was told that the Medical Adviser didn't think my sleep apnea was severe enough!!

The main reason I'm upset is NO WHERE does it state in the insur. requirements that it depends on the degree of your sleep apnea...... I figured you either have it or you don't.

Iv contacted my PCP to help me with the appeal but I have no idea what to do. I mean if they denied BC my sleep apnea is "mild"  then I'm kinda at their mercy, or I feel that way.

I don't want to gain the weight to be 200% and I don't really have anything else wrong with me that I haven't mention.

Does anyone have any advice for how to get around this? I mean how bad to I really have to be in order to get the help that is needed. I'm really upset with this insur. company

 You just need to appeal. Some insurance companies deny because they can. I really don't think that they can deny you because your sleep apnea "isn't severe" enough. Sleep apnea is sleep apnea.  If you meet NIH criteria for WLS then your insurance has to go by that, include that in your appeal, along with Medicare's requirements for WLS which are pretty much the same as NIH. Which surgery are you trying to get? If it's the band, RNY or the DS then it should be a covered benefit (if they cover WLS in general in your policy) because those 3 surgeries are not considered investigational or experimental by NIH, Medicare or the CA DMHC. Once you've exhausted all  your internal appeals through your insurance you can contact the DMHC and have them do an IMR (independent medical review) for you. I have info on my page if you are interested.

if you need help with an appeal, send me a PM  and I will be glad to assist