Anyone here denied due to lower BMI?

Hi LIghtweights!

I normally post on the DS board and have been thinking that I should post here too since I am a lightweight. I just received a denial letter from Anthem Blue Cross CA stating that I was denied because my BMI is 36.9 and I didn't have a severe medical problem that warrents the surgery. I have had chronic hypertension for the last 15 years that is controlled by medication that has to constantly be adjusted. 

I was wondering if anyone on the lightweights forum has successfully appealed this type of denial? I would really appreciate any input you an offer.

shelly

First of all I just want to say I know NOTHING about appeals.......BUT I do want to say this......YOUR CHRONIC HYPERTENSION IS NOT CONTROLLED BY MEDICATION WHEN YOUR MEDICATION REQUIRES CONSTANT ADJUSTMENT!  THAT IS ONE THING YOU NEED TO PUT IN YOUR APPEAL!!!!

I had Health Partners Insurance when I had my surgery.  My surgeons office stated my HBP was uncontrolled with medication after only being on it for 1.5 months with ONE adjustment having been made with no drop in BP as well.......I'd be curious to see what your physicians have said about this supposedly controlled HBP that needs constant med adjustments to your insurance company!

I would take a picture of all the pills you take on a daily basis as well as a list of your meds you've had adjusted umpteen million times over the last 15 years to try to maintain your HBP.  Along with documentation of your BP readings..........I'm sure others will chime in........BTW what is your normal BP??  Mine was 142/86......the day my PCP put me on meds.

Well, most of my adjustments are made due to weight loss or weight gain. I have yo-yo'd for the last 15 years.  I will get my bp med and reading history from my PCP (I have been seeing her for the last 9 years). 

I think when I was put on meds originally my bp was 150/106 or something like that. I went to urgent care for an ear infection and the doctor there almost fainted when he took my readings, especially since I was only 27 at the time. I think right now my readings have been in the 130's/70's range with two meds (one includes a diuretic). If my bp starts creeping up then I will have to add a 3rd med since I am maxed on dosage for the other two.

Thanks for your input!
shelly

Hi Shelly. Welcome aboard. Blue Cross has umpteen loop holes to put you through...can't stand them. Did Diana Cox or Larra respond to on the DS board. They're pretty awesome when it comes to dealing with insurance in CA.

I think documenting your BP meds is an excellent idea and maybe your surgeon's office will have a sensing if that might help your appeal. Don't give up!

--gina
 

Hi Gina,

Thanks for the welcome!  Yes, Diana did respond to my thread on DS and I posted some med policies for Anthem BC regarding WLS.  I guess I was naive in thinking that I meet the insurance criteria of having a BMI over 35 with a co-morbidity of high blood pressure.  It was my PCP who felt that I should look into WLS after all of my years of yo-yo dieting and dealing with high blood pressure.

I am going to call my PCP today and see if she will help me out or at least send me some documentation in regards to my weight history and BP meds.

shelly

Do you have sleep apnea?  Many of us do and don't even realize it.  For me it was one of the things that helped me get approval.

I was tested about 8 years ago (and at least 15 pounds light if not more).  At that time I did not have apnea but my pcp had mentioned the possibility of testing again since my husband constantly complains about my snoring and I seem to have all the other symptoms.

I would get tested again then for sure!  Hopefully (well you know what I mean!  LOL) you do have SA and it'll get you your approval!  :0)

 I also live in CA. I had to have two co-morbidities since my BMI was under 40 with my Blue Cross/Blue Shield. I developed type 2 diabetes. I guess I should be grateful I have always had high cholesterol and could not take statins due to a liver problem.

Keep appealing any response you disagree with. When you call, get a name and location and keep track. That has helped me many times. 

I like the idea of pictures of meds. It takes persistence, but its worth it to get your health back.

Good luck!!!!

Hi Trxxyy welcome to lightweights! I'm sorry you were denied. I was denied also because my BMI wasn't high enough so I ended up being self pay. I hope you figure out a way to get them to change thier minds! Good luck to you!