Here's my story and I hope someone can help. I attended my first appointment with my surgeon and was given the checklist that I would need to complete to submit for insurance. I went through EVERY appointment, every test, even things I didn't think I needed to do. After all was submitted, my doctor's liason says the insurance coordinator is saying I will most likely not qualify. I have high blood pressure (only one med/but it has 2 meds in one pill). but then again it is not a bad enough condition. I had BMI of 38 and 39 for the past 2 years and am up to 41 BMI now. But now am told that those 6 pounds 2 years ago is enough for me to get denied. What should I do? I can't go back in time and I don't want to have to go through all the pre appointments again. Why wasn't I told I would be denied after they got all my weight records and knew my medical history. Did I mention they found a hiatal hernia when scanning for upper GI.. that explains all the pain I feel in my chest. Is that considered a sufficient co morbidity? I just don't know what else to do. Does anyone have any knowledge of my steps.
BCBS Federal/ why am I jumping through hoops
- Thread starter rhondaw
- Start date
no, just the heads up of "you are probably not going to qualify". I am so depressed.
Welcome @rhondaw
First, BREATHE.
Second...what the doctor's office says is NOT set in stone. Wait til you either get approved or denied BY BCBS Fed. Do NOT let the people at the surgeon's office who honestly don't care on way or another control YOU.
IF you are denied, then there are people here who can help...but you need a copy of the denial letter from BCBS Fed before going for an appeal. You can't appeal if you don't know why you were denied and until you get the letter in hand, it's all spinning wheels. And who knows, you may surprise them and be approved.
First, BREATHE.
Second...what the doctor's office says is NOT set in stone. Wait til you either get approved or denied BY BCBS Fed. Do NOT let the people at the surgeon's office who honestly don't care on way or another control YOU.
IF you are denied, then there are people here who can help...but you need a copy of the denial letter from BCBS Fed before going for an appeal. You can't appeal if you don't know why you were denied and until you get the letter in hand, it's all spinning wheels. And who knows, you may surprise them and be approved.
I actually already feel better now that I have found this group. I didn't know where to go. I want to thank you for having this forum in place. I will let you know if I get the approval or not.
Larra
Well-Known Member
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- Dec 31, 2013
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And if you are denied, get a copy of your EOC (evidence of coverage) to determine exactly what the rules are for bariatric surgery in YOUR policy. This will also inform you as to your appeals rights, if any. There are gazillions of different policies. And if you think the folks at the surgeon's office don't care, they are far more caring than anyone you might talk to at the insurance company, so it's your responsibility to read the policy for yourself and not trust anything they tell you over the phone. With the policy and your denial letter, if you are denied, you will know how to proceed. You also need to know if your policy is self funded or fully funded. @DianaCox can explain that part better than I can.
And for future reference, document everything. Save all mail emails, etc. Document every phone conversation with your insurer (and with HR if they are involved) with name, job title, phone number, date, time, and summary of conversation. You never know what you may need in the future.
And for future reference, document everything. Save all mail emails, etc. Document every phone conversation with your insurer (and with HR if they are involved) with name, job title, phone number, date, time, and summary of conversation. You never know what you may need in the future.
Munchkin
Full of Fairy Dust
How tall are you? I would BET you are shrinking.
Larra
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You can get your height rechecked, preferable at the end of the day when you are at your shortest (seriously, we really are a bit shorter at the end of the day, esp if we are on our feet a lot). This could raise your bmi just a bit. Every little bit helps.
Yeah, but 5' barefooted? And checked in the last month?
Munchkin
Full of Fairy Dust
And I am absolutely positive carrying around all that weight has had a negative effect on your posture too. Actually your posture sucks and you slouch now.
newanatomy
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- Jan 5, 2014
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- 2,983
The nurse at my PCP's office told me I grew a whole inch after my DS. Who knew? I thought I had always been 5'8" but my pre-op paperwork says I am 5'7". Now, I have it right again.
Clematis
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- Sep 5, 2015
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Because I knew I'd be borderline 40 BMI, I slouched my way from just under 5'5" to 5'4" -- the inch in height makes for an 8# difference in a 40 BMI. Also get weighed after you've had a big meal, not gone to the bathroom, wearing heaviest clothes and jewelry -- just the opposite of how you've weighed yourself your entire life. 
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