well I spoke with the insurance co and its the plan language that's the issue and the insurance coordinator at the clinic said that I may need to prepare for the dr and myself to write an appeal letter to the board of directors at my hubbys union since that is who the insurance is admisitered through. So im hoping that my prayers will be answered and I could have surgery by the end of the yr due to decuctable and not have to shell out more dollars come janurary. I feel like giving up but know I cant because ive went to far with the weight loss and hope the power of the pin will come through. im also prepared for my cardiologist to write a letter if need me and submit that too cause I know every little bit helps

The doctors office should sure be able to help. I'm sure you are not the only one in this situation. Hang in there!!!!

My insurance company was glad to pay for mine because they know that with the surgery eventually they will stop paying for cpap supplies! I was at the Dr.'s today and they took one of my blood pressure pills away! I just had surgery on the 2nd of December! Just hang in their and have you doctor write that letter anyway, it can't hurt!

I officially got the call stating I was denied surgery cause now that I lost some weight my bmi dropped to low past their guidelines. The only insurance that they have heard of that went by ending bmi and not starting. So now I will get a letter in the mail to start the appeals process. Has anyone went through the appeals process and if they got approved or not

I officially got an update on Thursday evening that my insurance fixed it to where if my bmi went up then I would be approved for surgery in jan. Because I lost 16.5 lbs my bmi is now below their guidelines to cover surgery even though my bmi was 52.2 when I started. I was told most insurances go by starting bmi but with my insurance it isn't the case. I have the medical necessity just not the bmi. in a nutshell the insurance basically told me in a round about way that I would have to gain 6 of the pounds I lost to be approved for surgery which is crazy. The doctor isn't happy that im going to have to gain to get approved for surgery and the clinic im going to said they have never worked with an insurance that requires a bmi of 50 or higher to be approved for surgery even though it would save the insurance co in the long run cause they wouldn't have to pay for all the medications and dr appts involved with my comorbidities. So now I have to wait until Jan 2014 and shell out over 600.00 just because of the insurance guidelines. There was confusion in the beginning anyway due to where my insurance is admistreted through my husbands union and not anthem. So due to the fact that the clinic the only one in my area unless you go an hr away has never worked with Kroger insurance through a union and had no clue about it. They couldn't get the whole pre cert for my 6 mos weight loss right. I don't want to have to go to the other clinic which is an hr away. So hoping that ill get to have surgery come jan 2014