Afraid I'll be denied

I think my medical group will deny my PCP referral to a Surgeon for an evaluation. A form that my PCP office had me fill out stated that if I have a BMI of 40-49 than I needed to have at least 1 co-morbid to qualify. I have a BMI of 42 but no co-morbidities. Can I file an appeal to my insurance co? Does anyone have any advice? Thanks, Wendy

Try anyway. I don't know what your help is like but if you are boardline maybe your doctor can write it down. I am boardline high blood pressure (if I wasn't about to have surgery they were talking about putting me on medication). See what you can do, don't give up. Trust me, it took me 7 months to get approved, but its worth the wait if you are ready to make this kind of change.

Call the insurance company directly and ask what their requirements are. I have BCBS of NC and their requirement is 35 with co-morbidities or 40+ with no co-morbidities for 4 years or more. As a note of inspiration - I had to send in 5 years weight history. For two of the years I was over 40, two of the years I was between 35-40 and one year I did not make 35 at all. I have no co-morbities that they look for.... only varicose veins and a fatty liver.... and I was approved I never thought I would - I did have to appeal 3 times - but it cant hurt to try! I worked for the insurance company for many years so I already expected to be denied the first go around - many people dont get approved right off the bat. So find out what their requirements are and also find out their appeals process!!

I think we're all afraid of it. Do you have any medical history in your family?

Yes, I do. My mom has diabetes, heart disease and hypertension, and both of my sisters are morbidly obese as well. I think I'll start preparing my appeal letter right now just in case. That way I'll be ready if and when I need it. Wendy

I had Blue shield of CA HMO.. hills physcians. I didn't have any comortalities. I was approved easily based on my family history. I was 46.1 when I was approved! Goodluck. Insurance companies can be so shady. Sometimes it's a real kick to the ego when some random person decides your fate!

We dont have the same Insurance co but i was also afraid that i would be denied. My BMI is 48 and only have one co-morb. But when i wrote my letter for the Insurance company i let them know about my family medical history and told them that i am at high risk for for future health risks. It was kind of like pay for this surgery now or you'll pay later kind of deal.

Do you have joint pain or heartburn or anything? I thought I didn't have any co-morbids but I do. Write down every little thing that you can think of to put in an appeal letter if they deny you. Don't be discouraged!!!!