Question
Hi I am from Birmingham Alabama. I am writing concerning my insurance bcbsal. They denied my insurance for gastric bypass surgery stating that I did not meet the coverage criteria established by their medical staff. They said that I didnt have 3 years of documentation indicating that I had been morbidly obese for at least three years and I only had two years and also that I didnt have 6 months of a weight loss program but I had just finished 6 months before surgeon sent in my medical files. Can you tell me if it would help to appeal the insuranc or not. Thank You
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What is the name of your state?What is the name of your state?Alabama
What is your question and please provide the facts?
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Hi I am from Birmingham Alabama. I am writing concerning my insurance bcbsal. They denied my insurance for gastric bypass surgery stating that I did not meet the coverage criteria established by their medical staff. They said that I didnt have 3 years of documentation indicating that I had been morbidly obese for at least three years and I only had two years and also that I didnt have 6 months of a weight loss program but I had just finished 6 months before surgeon sent in my medical files.
She stated the facts right here!
Can you tell me if it would help to appeal the insuranc or not. Thank You
And here is her question!
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And here is her question!
If you notice OP edited it in response to my question.
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Hi I am from Birmingham Alabama. I am writing concerning my insurance bcbsal. They denied my insurance for gastric bypass surgery stating that I did not meet the coverage criteria established by their medical staff. They said that I didnt have 3 years of documentation indicating that I had been morbidly obese for at least three years and I only had two years and also that I didnt have 6 months of a weight loss program but I had just finished 6 months before surgeon sent in my medical files. Can you tell me if it would help to appeal the insuranc or not. Thank You
The insurance companies have very good reasons to put restrictions on this type of surgery especially if you lack a chronic history of morbid obesity. There are many health compilcations from this surgery and you really need to continue your weight loss efforts in earnst. You will be healthier in the long run if you can control your weight with diet and exercise than surgery. Please continue and then re apply in the future. How many pounds overweight are you and is there a trigger to this?
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I didnt ask what you thought abought my weight I ask if you thought I should appeal. I am morbidly obese High blood preasure on 2 different pills for this and sleep apnea. You dont know my life and how hard I try losing weight.
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Here from alabama. You dont know what kind of diets I have been on in my life. I am 41 years old and I have high blood preasure that I take 2 pills a day. I also have sleep apnea where I quit breathing at night. You dont need to know how much I weight to answer my question. What are you some kind of doctor your self and where did you get you medical degree at.
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It's entirely up to you whether to appeal or not; that's not a decision anyone else can make, particularly with only a paragraph's worth of information.
If you do not meet the requirements under the plan, it is quite unlikely that you will prevail under appeal. An insurance policy is not a guarantee that all bills will automatically be paid no matter what; IF you meet the qualifying guidelines they are required to pay; if you do not they have no such liability.
However, it is also true that an appeal that is never filed, is GUARANTEED to fail.