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Being Obese Is Pre-Existing...duh!

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Started by Kdubb, Jun 16, 2012 4:24 PM
8 replies to this topic
8 replies to this topic

    Kdubb

    Novice

  • Posts: 13
  • Joined: Jun 2012
  • Gender: Male
  • Location: IL
  • Surgery: LAP-BAND
  • Surgeon: Peter Rantis
  • Surgery Date: Aug 2012
  • Height: 5 feet 11 inches
  • Starting Weight: 350
  • Weight Lost: 0
  • Current Weight: 350
  • Goal Weight: 200
  • BMI: 48.8
Posted June 16, 2012 - 4:24 PM

#1
So I got a call form the doctor's office saying my insurance company has authorizes my surgery (yay)...but the catch, I cant have it until October 28th because I have a pre-existing condition. When I asked what it was, they said my obesity. WTF? lol duh, I didnt get thin, then big again.

So i have been calling and calling to try and figure this out.I have good insurance, its a PPO even have a coworker that got the band done 2 years ago. Same insurance, didnt have this problem. I know 2 years is a long time, but how is this a new thing? I have never been seen for obesity before, so how is it pre-existing?

Anyone having this problem or know how to solve it???


    Jim1967

    BariatricPal Host


  • Posts: 1,596
  • Joined: Aug 2011
  • Gender: Male
  • Location: NH
  • Surgery: LAP-BAND
  • Surgeon: Michael Jiser
  • Surgery Date: Apr 2012
  • Height: 5 feet 6 inches
  • Starting Weight: 488 lbs
  • Weight Lost: 323 lbs
  • Current Weight: 165 lbs
  • Goal Weight: 170 lbs
  • BMI: 26.6
  • My Blogs
Posted June 16, 2012 - 4:52 PM

#2
I agree this is rather odd. I am wondering if they want you to do a supervised diet or prove you've made attempts previously to lose it on your own. My insurance company required a 6 month supervised diet and fitness plan from my doctor and nutritionist. I have never heard of such thing as obesity being pre-existing!! That is the most ridiculous thing I ever heard. I would definitely call the insurance company and press for clarification and asked for their written policy on bariatric surgery.

Remember you are the customer....you have rights to the information.

Good Luck


    Kdubb

    Novice

  • Posts: 13
  • Joined: Jun 2012
  • Gender: Male
  • Location: IL
  • Surgery: LAP-BAND
  • Surgeon: Peter Rantis
  • Surgery Date: Aug 2012
  • Height: 5 feet 11 inches
  • Starting Weight: 350
  • Weight Lost: 0
  • Current Weight: 350
  • Goal Weight: 200
  • BMI: 48.8
Posted June 16, 2012 - 4:56 PM

#3
I know right? I showed them records of having a personal trainer, who was also a certified nutrionist. I saw him for over a year, and on my own out of pocket. Also showed them my meals, cause I record almost everything I eat. Not going to lie, when Im out on the run i dont ALWAYS write it lol.

I have calls in to several people at the insurance company to try and figure this out. My insurance only requires a few classes be taken, which I have done.


    TreehouseLady

    Advanced Member

  • Posts: 40
  • Joined: Jun 2012
  • Gender: Female
  • Location: NA
  • Surgery: LAP-BAND
  • Height: 5 feet 8 inches
  • Starting Weight: 250 lbs
  • Weight Lost: 50 lbs
  • Current Weight: 200 lbs
  • Goal Weight: 175 lbs
  • BMI: 30.4
Posted June 16, 2012 - 5:08 PM

#4
Wow, and I thought I was having a bad day :(
So sorry to hear this. It's really unacceptable, but nothing seems to surprise me anymore.


    Jim1967

    BariatricPal Host


  • Posts: 1,596
  • Joined: Aug 2011
  • Gender: Male
  • Location: NH
  • Surgery: LAP-BAND
  • Surgeon: Michael Jiser
  • Surgery Date: Apr 2012
  • Height: 5 feet 6 inches
  • Starting Weight: 488 lbs
  • Weight Lost: 323 lbs
  • Current Weight: 165 lbs
  • Goal Weight: 170 lbs
  • BMI: 26.6
  • My Blogs
Posted June 16, 2012 - 5:12 PM

#5
Well the good thing is they didn't say NO. Actually, they said sure at the end of October. I would still press for more answers and policy in writing.


    Kdubb

    Novice

  • Posts: 13
  • Joined: Jun 2012
  • Gender: Male
  • Location: IL
  • Surgery: LAP-BAND
  • Surgeon: Peter Rantis
  • Surgery Date: Aug 2012
  • Height: 5 feet 11 inches
  • Starting Weight: 350
  • Weight Lost: 0
  • Current Weight: 350
  • Goal Weight: 200
  • BMI: 48.8
Posted June 16, 2012 - 5:26 PM

#6
Jim 1967 That is true, at least they said it was approved. But what I want to know is, what happens if I gain more weight, or do i need to redo all the tests and classes I have done then..what. Obviously once I get a hold of a live person from the insurance company I will get these answers. Who knows...just a really strange occurence.


    Jim1967

    BariatricPal Host


  • Posts: 1,596
  • Joined: Aug 2011
  • Gender: Male
  • Location: NH
  • Surgery: LAP-BAND
  • Surgeon: Michael Jiser
  • Surgery Date: Apr 2012
  • Height: 5 feet 6 inches
  • Starting Weight: 488 lbs
  • Weight Lost: 323 lbs
  • Current Weight: 165 lbs
  • Goal Weight: 170 lbs
  • BMI: 26.6
  • My Blogs
Posted June 16, 2012 - 6:01 PM

#7
Indeed, very strange. Good luck!!


    Mystie

    Expert Member

  • Posts: 199
  • Joined: Jun 2012
  • Gender: Female
  • Location: PA
  • Surgery: Gastric Sleeve
  • Surgeon: Richard Boorse
  • Surgery Date: Jan 2013
  • Height: 5 feet 10 inches
  • Starting Weight: 365 lbs
  • Weight Lost: 182 lbs
  • Current Weight: 183 lbs
  • Goal Weight: 175 lbs
  • BMI: 26.3
Posted June 16, 2012 - 6:30 PM

#8
One of your doctors probably tacked the diagnosis on your visit at some point without you even knowing, guaranteed. Granted, they SHOULDN'T be sending in claims to your insurance listing obesity unless they're actually treating you for it, but they do it all the time. I work in billing and lots of docs just add the diagnosis in with the mix of whatever they're seeing you for. My OB/GYN even put it down during my pregnancy.


    xavtay2

    Guru in Training

  • Posts: 232
  • Joined: Apr 2012
  • Gender: Female
  • Location: FL
  • Surgery: LAP-BAND
  • Surgeon: Robert Marema
  • Surgery Date: Sep 2012
  • Height: 5 feet 6 inches
  • Starting Weight: 262 lbs
  • Weight Lost: 26 lbs
  • Current Weight: 236 lbs
  • Goal Weight: 160 lbs
  • BMI: 38.1
Posted June 16, 2012 - 8:01 PM

#9

So I got a call form the doctor's office saying my insurance company has authorizes my surgery (yay)...but the catch, I cant have it until October 28th because I have a pre-existing condition. When I asked what it was, they said my obesity. WTF? lol duh, I didnt get thin, then big again.

So i have been calling and calling to try and figure this out.I have good insurance, its a PPO even have a coworker that got the band done 2 years ago. Same insurance, didnt have this problem. I know 2 years is a long time, but how is this a new thing? I have never been seen for obesity before, so how is it pre-existing?

Anyone having this problem or know how to solve it???


Hello at least they did not deny you! I would do what several people have stated continue to call the insurance company for more information. You have rights I am fighting now to have my denial appealed! I am working with the FL department of Ins, our HR advocate and I am filing an appeal directly with the insurance company! At least they didn't NO best of luck


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