Question:
I just found out today that I am denied for the RNY surgery. I have BCBS/PPO State

insurance. I have no comorbilities, just had a blood clot last year and have feet swelling now. I am 350 pounds, 5'4. How long does an appeal take and can anyone give me some advice about it?    — Judy W. (posted on March 20, 2002)

March 19, 2002
Do you have a letter from BC/BS telling you why you were denied? If not, make sure they send you one. You can't really know what to do until you have that. If it's an exclusion in your policy, that's pretty tough to get around. However, it could also be that they don't have enough information, or the right surgery codes, or whatever. If it's just a matter of not having complete information, have your doctor fix that and then re-submit. If you end up having to file an appeal, keep it short and to the point. Don't give them your entire life's story or talk about not being able to fit in an airline seat, etc. Reply only to the reasons they gave you for being denied. Remember that the people who will act on that letter get many, many of them. They only want to see the relevant information. If you've ever read any articles on effective complaining, they always say to keep the complaint letter to one page. The same is true for insurance appeals. Good luck.
   — garw

March 20, 2002
I can not believe that they would deny someone who is over 300 pounds! I also have BC/BS PPO. Did you have suffiecient imfo about the length of years at which you have been overweight? My gyn supplied all of my imfo. I had only seen her for barely three years and that's all I needed. (as far as doctor notes) I also had to list all of my diet attempts. If I had any pain at all, I used it as a comorbidity. I had none. I just complained of back or knee pains and the surgeon put that in his notes. I hope you do get approved, never give up.
   — Stephanie N.

March 20, 2002
I work for an insurance company, what state do you have? They should have sent you a copy of the letter that would have been sent to the dr's ofc. I would check to see why you were denied? I weight 321 and 5'4 and I have back pain and knee pain thats all and mine was approved in an hr after the ltr was rcvd. I would call and see why you were denied? Do you have a pre exsisting condition on your plan? I would call and check asap. Mindi
   — Mindi M.

March 22, 2002
hi. I too have BCBS-PPO and was denied initially for my surgery. Make sure your dr put the bcbs operation code down as MORBIDLY obese and not just obesity. There are 2 different codes. I was initially denied by BCBS b/c the dr put down the wrong code. Get them to resubmit your request with the other code and see if that works. If they deny you again, Fight. Use obesitylaw.com. Don't give up. Good luck.
   — Renee V.

September 6, 2002
This surprises me, as I had no problems whatsoever and I also have BCBS PPO. I definitely would apeal, appeal, appeal!!
   — Jaye S.