Can somebody offer help/advice for getting approved with BCBS of NC PPO?
I have BCBS PPO of NC. I received my frist denial for surgery because I did not meet their required 40 BMI for 5 years. My surgeons office sent ALL my weights from every visit to BCBS instead of one a year like they said they would. This is an issue because for a year and a half I was taking OTC diet pills and my weight dropped down to 196. For 2 of the 5 required years at my heighest weight I didnt meet the 40 BMI. One year I was at 39.5 and the other was 36 or 37 (cant remember off hand). When I stopped taking the diet pills (when ephedra was banned) I gained ALL the weight back plus a few pounds. I dont have any of the co-morbidies they typically look for but do suffer from varicose veins, rashes and a fatty liver. There are numerous medical problems that run in my family. I filed an appeal and was again denied stating I didnt meet the medical necessity. Any suggestion for what I can put into my next appeal letter?
We greatly appreciate your interest in helping us build our Q&A database. To discourage vandals from posting garbage, however, we require people to register before posting.
You must be logged in to post an answer. Click here to log in.