Yesterday received word that I am "DENIED" I guess I do not meet the BC/BS statistics to have this operation. I have a BMI of 40 and high blood pressure. I am only 5"2 and weighed 220 at the start. I just spent the last three months totally consumed about attending my classes, going to nutritionist, losing my 5% and now this Bull. I am at work right now and feel like having a good cry but cant. They tell me to appeal and a decision will be made in 30 days. If they wanted me to have the surgery in the first place I would not have been denied. Is appealing this a waste of time? I was angry at the center for weight management that took me in. Why did they accept me into the program if I do not qualify?

Today, Well, my doctor's peer to peer session with BlueCross/Blue Shield was not successful. I have a bmi according to the insurance of 39.8. I need to be 40. I only had three pounds at my initial weigh in and I would have qualified. I am going to send my own appeal tomorrow. The program director where I have been going to was not very clear on what my next steps with them are. She told me to come back in a month and get weighed again and they will resubmit to the insurance. This means that I have to gain back all the weight i lost, 9lbs, and gain a few more. Doesn't that seem kind of moronic? I am in the program to help me with my weight problem not get heavier. I am thinking of driving over to their office tomorrow and talk to someone one on one. I put a lot of myself into this and disappointed is an understatement as to how I feel right now.

That is majorly dissapointing! I am so sorry this happened to you, but stay encouraged. Denial is not final. Just keep it moving. If you need to start over with the 3 months do it so that you can get approved. Lots of people on here have done appeals. I would not give up just yet.
Insurance companies do not want to pay for this surgery, so they try to deny as much as they can. So were you tested for any and all commodities. Like are you for sure that you do not have sleep apnea which would allow you to meet the requirement of have over 35 bmi with a co morbidity.
Request to have as many test run on you as possible. You might have some underlining issues that would qualify you. Secondly, Appealling doesn't hurt especially since I hear that many people have had to appeal at least 3 times before they were approved, so just shake this off and make a plan B.
If this insurance does not work, maybe you can wait a year and apply again. Or you can research if you can afford to pay out of pocket in installments

I'm so sorry to hear this. I've wondered myself if my BCBS will use the same calculations to get my BMI as my doctor because I am right on the edge as well, in fact i'm a tiny bit below according to my doctor yet when i use any calculator online, i'm above 40. But, in any case, I'm very sorry, i'm sure it is disappointing especially since you dug in and did everything you were supposed to go for their pre-op requirements. I hope that if you appeal it works for you! It's certainly worth a try. Good luck!

I am so sorry to read this but I can TOTALLY relate. I, too, have BC/BS and I had to go through 6 months of visits, all the evaluations, and I even had a sleep study done to get a sleep apnea diagnosis (which I did by the way). I don't know how your coverage is but with my coverage there are astronomical deductibles, and co pays. After I spent all of the money out of pocket (somewhere between $2000-$3000) on classes, doctors visits, and travel expenses to appointment....oh yeah, and time off from work for those appointments, I was denied! I can't fully explain how livid I was when I was denied and then given some of the same options you were including starting process over (which means gaining back what you lost and then some....yes, that is moronic), appeal, or resubmit! I too, felt like my surgeons office was aware of the fact that my denial was a great possibility (I was denied because my bmi had not been above 35 for the last 2 years consecutively....most yo yo dieters don't have the same bmi from one year to the next). So I had done some research about gastric sleeve in Mexico. I was so disgusted after I got off the phone with my patient coordinator, I called the Mexico surgeon I had decided on and put down my deposit. I paid for my surgery out of pocket and spent about what I spent in the States with all the travel and expenses and had my surgery in March! I couldn't be happier with the outcome. I am not trying to sway your decision in any way. I am just saying that with a bmi between 35-40, insurance companies will look for reasons to deny coverage. I am presenting you with another option. I wish you luck with whatever you decide and good luck getting to the sleeved side!!