Insurance denied
on 1/6/17 5:02 pm
I know I will appeal because I am considered obese. I take BP med and was to have gall bladder removed at the time of procedure.
Insurance explanation: Per the notes, rationale for the recommendation to deny: bmi less than 40 w/htn, 2 meds documented, wt gain during program.
Any suggestions or advice why I am denied is appreciated. Unsure what "htn" stands for in the explanation above.
Htn= hypertension. Weight gain during program was a emphasized by my surgeon over and over that insurance would not approve if I gained weight from my first weigh in at consultation visit.
on 1/6/17 5:23 pm
Good to know. Thank You. My surgeon never mentioned that insurance would deny due to weight gain after first weigh in. The classes I attended spoke on life after the procedure, never talked of maintaining my initial weight. And also when I had my psyc. eval. the dr. told me if I lost weight insurance would deny because I was borderline at 35 bmi. Feel badly that I didn't know this ahead of time.
Thank you much.
The criteria set by each insurance company can vary, but a common criteria is bmi that is between 35-40 must have 2 coexisting comorbities (i.e. apnea and high blood pressure). If you have a bmi above 40 you are just plain fat enough. I have read over the years a few people who lost during the preop portion below 35 and then were denied.
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