Denied

Yesterday I had my appointment with my surgeons dietian, today I called my insurance, BCBS pers North Dakota and they denied me, they said I did not have a BMI of 40 for three years, and I had no Co- morbids,  the first of which is true, but I have arthritis, gerd, high clorestrol,  hiatel hernia and I have an appointment for a sleep clinic  appointment for the 9th of July, So evidently when they sent the letter to the insurance they didnt put down my co-bids. So now what? I have been through all the hoops, I am so frustrated I could just scream. I guess I  will just have to wait and see. I am just so sad. Well thanks for letting me vent. Loretta

Don't give up, appeal. Not just that but you can send them a letter yourself, stating why you think you need the surgery and what problems you have and how it would benefit them in the long run if they allow you to have this surgery. Don't give up, people sometimes have to fight a 6mos to a year but they do eventually get approved. Keep you in my prayers that they will approve you soon!

Don't give up! My sister had BCBS of Illoinis and she fought it 5 times. She had it done in March. She kept track and went back andf did the paperwork herself and found out the clionics, and Dr and nurses dodint turn in the paper work required. Aks for copies of what was turned in to the insurance to review it. Peggysue/Fargo

Hi, Thanks for you help and your support. I will continue to plug away. I have a slep apnea study on the 9th keeping my fingers crossed. Thanks again Loretta

Loretta: hang in there. Even with my way over 40 bmi (i think im 47) the insurance person for doc howell felt better turning it in with sleep apnea. she said sometimes it goes through easier with the co morbs. get in writing all your co morbs and keep communicating. you can do this!  (hope you are still reading this thread - i am late!) keep us posted. judi

Hello Judi, Thanks for the support. I havent been on for awhile as I have been a bit depressed. I tried calling the doctors nurse for two days in a row and left a detailed message of what was going on, but I never received a response, so Im not sure what to do next. I have a sleep apnea appointment on the 9th, then I just dont know where to go from there. You mentioned getting in writing my co- morbids, from my primary phyican? Well one thing at a time. Any suggestions is always greatly apprciated. Thank you!!!! Loretta

Hi Loretta, Do not give up.  Let me tell you something that happened to me; at least with my insurance (NDPERS - BSBCND).  They will cover this surgery with a bmi under 40 with UNCONTROLLED comorbiditiies.   This one almost tripped me up.  My bmi was 39, but I had been diagnosed with sleep apnea two weeks before this was submitted to my insurance company.  I got a CPAP, and for a while, it seemed to help.  As soon as the insurance company saw that I had sleep apnea but it was controlled by CPAP, they no longer counted that co-morbidity.  Same goes for high blood pressure, high cholesterol.  If you have been diagnosed, you need to be on medication and have the medication not work.  So, I got denied, and they denied the appeal.  That was last August.  I had surgery on July 2nd (yup, 5 days ago).  I kind of gave up for a while and went on to living my life, then in March, I decided to try again.  I made an appointment with the doctor who diagnosed my sleep apnea, as I clearly had uncontrolled sleep apnea and was not tolerating the CPAP well at all.  He wrote a letter to me, copied my insurance company, indicating that my sleep apnea was getting worse and that it was uncontrolled.  Two weeks later I was approved. Keep on fighting, and good luck.