Question:
I've been denied by BCBS IL PPO for

Does anyone have any ideas as to how I should appeal something like this? I have a letter drafted and had been a a Dr. supervised visit as well as gone to the informational lengthy meeting, had tests done, etc., but still denied because of that. Please email [email protected]    — Amy E. (posted on August 20, 2003)

August 20, 2003
Maybe it's just how my system shos things, but... It sounds like you've said somewhere why you were denied, but I don't see it. That's an important piece of information to be able to help you. Can you elaborate?
   — Vespa R.

August 20, 2003
Now I'm getting nervous... I too have BCBS IL PPO and the doctors office has just sent in my paperwork for them to review. I also am a "lightweight" with a BMI of 40. I don't have diabetes or hypertension but I do have a few other co-morbidities like GERD and joint pain. I haven't prepared myself for possible denial! I can't give any advice myself but I would appreciate if you would let me know how everything goes after your appeal!
   — Kara J.

August 20, 2003
Amy, Unfortunately you do not meet the National Institute of Health standards for this surgery. You do not have any serious co-morbs and have a BMI less than 40. What was their reason for denial? If it's for the reasons I stated then there isn't much you can do. If it's for some other reason then you might stand a chance on appeal. I know someone who was a 42.5 BMI but did have sleep apnea and she got approved in 2 days. So I'm guessing it's because you are falling below the standards.
   — zoedogcbr

August 21, 2003
I had an open rny last januarary 01/21/02 and have lost 180 pounds since. I am on the way for a lower body lift. Point is, I was covered for surgery by BCBS PPO of Illinois. I was covered under my mothers plan, and even she had the surgery this year 06/09/03 and they covered. I also called them about my lower body lift and they told me that they see no problem in paying for it as long as I have excess skin. My opinion is that maybe you need to see another doctor..one who will fight for what you need. I will say this though...BCBS will not just pay because you have "mirror issues" and want to have the surgery because of it. I had asthma,bronchitis,mild sleep apnea, and weighed 400#'s at 5"11 at the age of 19.I was approved within a week, and got my date for the following week. My mother had type 2 diabetes, hypothyroidism(I dont know if thats how u spell it lol)lower back pain. She weighed in at 287#'s at 5'4 at the age of 41.I would seriously sit back and figure out exactly what your weight is contributing to your health, then go from there. Another doctor or even an appeal would also be a good start. E-mail me if you have any further questions.
   — Miko P.