Question:
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?    — poppy79 (posted on March 9, 2006)

March 9, 2006
Hi Jennifer, I am sorry to hear of your denial. I also have BCBS of NC as PPO. I would suggest getting a letter from your PCP stating the items that you have tried and recommending you for the surgery. That is one of the things that I did that seemed to help. It can be a struggle, but don't give up!
   — Rodeodreams