denied by Group Health

Hi all, I am a lap bander with a cousin in Yakima who has a bmi of 44. Group Health recently denied her RNY surgery saying she was not heavy enough. Does anyone know what it takes to get an approval from Group Health? She has several serious health problems related to her weight. I know denials are fairly common but there must be a way to get an approval. Any advice on dealing with Group Health? She was told that the surgeon she would have gone to is in Spokane. Thanks in advance, Donna

First of all she is entitled to appeal the decision. Her BMI should be high enough but maybe it hasn't been high enough for long enough, some companies require a high BMI for several years. She should see if her surgeon will appeal for her or even do it herself. Some ins. companies just automatically deny the first time in hopes that people will give up. Also try Obesity Law's website they help get approvals too. Good luck to her!

Hi, I was denied the first time by Group Health.  My BMI was 40-41.   I had sleep apnea, and once diagnosed, I was approved for either lapband or RNY.   I did have to write a appeal letter to the appeals department. From what I understand, you need a BMI of 40 with 1 co-morb or BMI of 50 w/ no heath issues.  Tell her to keep trying!! Sandi

I was denied at first by group health and my BMI was 62.  They (on my plan pebb) require 2 co morbidies.  I have two, but their doctors had not documented them suffieciently.  My appeal was successful after having there doctors re evaluate my sleep apnea and asking my doctor to switch my bp meds - thus he did an eval too.