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Approval process Pacificare ***


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  • Jul 21, 2011

Posted September 6, 2011 - 2:07 PM

About 2 months ago I went to the doctor thinking that with a 39 BMI with asthma, stress incontinence and fatty liver I would be approved with no problem. After being denied and appealing the decision I was again denied. Apparently my comorbidities weren't bad enough for the insurance. <_<
So after reading the evidence of coverage I learned that you have to have a BMI of 40 or over. A BMI of 35-39 had to have specific comorbidities. I just saw my primary doctor on Friday and am now a 41.78 BMI. She is submitting the request for authorization again. I have Pacificare Signature Value ***. I am almost certain I will now receive the authorization to meet with the surgeon. Which brings me to my question. I gained 15 lbs to qualify for the surgery. But I am right on the cusp. Should I attempt to start trying to lose a little weight before meeting with the surgeon or should I wait until I get into his office and have them record my weight first? The extra 15 lbs has made me even more uncomfortable than I already was! :(
I just am not sure if I drop a single pound that puts me under a 40 BMI that I will be approved.
I guess I am not sure if once I get the authorization to see the surgeon if I am approved for the surgery? Or if I have to see the surgeon first before I get the final approval. Does this make sense? Any help would be greatly appreciated. I feel like I am flying blind right now!B)

Thanks for the help!




 
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