need information please

I have gone through all the steps to have wls, but was turned down by my insurance.  (blue cross, blue shield of north dakota).  this took place in april.  at that point i became discouraged and put it aside.  i am ready to proceed again and wondering if anyone can give me any info on how to go forward.  i really do not have a pcp, but have seen heidi olson fitzgerald, so did schedule an appt with her on june 12th.  i am just under the 40 bmi mark and have been between 35 and 40 for the past three years.  and even though i have high cholesterol, i have chosen not to go on medication yet.  (trying to bring it down with diet, exercise etc)  but since that is not working, i am going to ask heidi for medication for high cholesterol.  will that help?  anything else you can think of would be greatly appreicated.  thank you for listening.  dyanna

A lot of people win on appeal, so don't lose hope & I think it's worth the effort.  I self-paid in Mexico b/c I had a duodenal switch & they simply do NOT cover it for anyone.  What did your denial letter specify as the reason for denial?  It might be b/c you haven't been attempting to control it through medication.  Don't take my word for gospel, though.  My thoughts?  Fight for yourself!  I know it's a time & emotional investment with ups & downs, but it's worth it.  If your appeal is denied, you can appeal the denied appeal using an independent third party.  I know of people on the DS forum who have won this way, so it is a possibility.

ditto what Lisey said, you need to find out specifically why you were denied. Sometimes it is simply a matter of more paperwork.

My weight was way over the 40 bmi but the insurance person at my doctor's office still wanted to document any comorbid I had, she said it all helped. So we tested me for sleep apnea and sure enough I had it

let us know what you find out and good luck!

My BMI was 39 when I got denied for insurance coverage.  I had just been diagnosed with sleep apnea, and was borderline high BP and high cholesterol, but not on any medication.

I really thought that my being diagnosed with sleep apnea, that would turn the corner for insurance coverage, but it did not.

Here is what my insurance letter said to me:  I had sleep apnea that was controlled by CPAP, so they did not count that as a co-morbidity.

I dropped it for 8-9 months, but still was sleeping poorly and extremely tired, so I knew I wasn't tolerating the CPAP.  I went back to the sleep specialist, who wrote a letter to BCBS indicating that my sleep apnea was not controlled by CPAP, and that the best thing to cure the sleep apnea was to lose weight.  Within 2 weeks, I was approved for surgery.

I guess I would just tell you not to give up.  Insurance companies want people to go away, and not fight.  Keep on fighting....and good luck to you.

Hi Dyanna--

I was just denied too! :(  I am going to try one appeal, and then will probably end up doing cash pay with Dr. Smith.

We have a lot in common, as I also see Heidi and my BMI has been between 35-40 for about 4 years. I have hypertension and am on medication, but according to my insurance, I either have to be over 40 BMI for 3 years or have BMI over 35 with high risk co-morbids. They dont' count my hypertension as "high risk" because I am on 1 medication and it is somewhat controlled. In order for it to be "high risk" it has to be uncontrolled and I have to be trying 3 medicaitons at 1 time!

Good luck to you! If you have any luck, let me know!

Amanda