Authorization denied ...

[Butterflyink13 5]

My procedure is scheduled for September 2nd and I've completed every appointment except for a second apointment with the nutritionist (that's scheduled for this Wednesday). The request for my authorization was denied. Then, the Peer to Peer was denied. So an appeal was filed on July 31. Just waiting for an answer. I hate that my surgery date is this close and I don't even know if it's going to happen. I had resigned myself to take it as a sign if the appeal came back denied that I would tell the surgeion's office not to file any more appeals (she said they can file 3 times). I've changed my mind as far as that's concerned. If they have to appeal 3 times and they're all denied, then I'll take it as a sign. Otherwise, I'll always wonder "what if" ...

Anybody get denied multiple times then then have an appeal approved? Just so frustrated and needed to vent.

[tera1982 194]

Not the same situation, but still understand the feeling. I'm losing it...

http://BariatricPal.com/index.php?/topic/349053-Feeling-hopeless%2E%2E%2E/page__view__findpost__p__3928887

[pindoctor 49]

I'm still waiting for my approval from insurance. Don't know why it is taking so long!

[Butterflyink13 5]

I called the insurance company myself today and they said they didn't see any response to my appeal yet. And that I should have an answer by the 30th. Hopeful before that since that's Sunday and will hopefully have surgery next Wednesday.

[peaceout 273]

I don't have any experience with appeals, but do they provide their reason for denying you?

It seems like they'd have to give you some feedback if you thought you met all the requirements but they thought you didn't. If you knew what the problem was, you could take steps to add whatever additional information they need?

[AngelaWilliamsMD 290]

Insurance companies can be so frustrating at times. I commend you all for being so patient...not so sure I could do it!

[Butterflyink13 5]

WingFan55

First off, my BMI is only (if you want to say only) 37. The reasons given were that (1) they felt my sleep apnea wasn't severe enough and (2) that they felt my high blood pressure was being controlled with my current medication. My surgeon and my PCP both felt confident that I would be approved for the procedure, not that anyone can know for sure until you're actually approved. I'm not sure of the exact conversation during the Peer to Peer, but my surgeon said the insurance rep was extremely rude to him and that there was just no talking to her. Pretty sure he said the conversation ended when the insurance rep hung up on him. So that kinda has me worried. Hopefully there will be a different insurance rep who will review the appeal and they'll be in a better mood. Fingers crossed!

[tera1982 194]

I'm sorry you have to go through all that! I know how stressful it is to be so close and something happen to postpone the surgery(I'm going through this as well, but I WAS approved from insurance-I was postponed due to abnormal labs). Please keep us up to date on what happens!

[JellyBellyNoMore 58]

I myself was denied and I am not sure why. I meet all of the criteria and have followed every instruction. I have filed a first level appeal and now I have to wait up to 30 days for a response.

If my BMI reaches 40 my insurance will cover without any other medical conditions. I am desperate enough to stuff my bra with dive weights if my appeal doesn't get approved. However, I worry they will make me start the process all over again.

I guess what I am trying to say is that I feel your frustration. It's hard not to be in control, but don't give up.

[pindoctor 49]

My approval finally came through today 2 days prior to surgery thanks to a diligent person from the insurance company who contacted the prior auth department. That's a far cry last Wednesday when the insurance company said they didn't know when they'd even have an answer. Argh! I had been biting my nails off for the past 5 days.

[Butterflyink13 5]

Last week I called the insurance company every day (one day I even called twice at the suggestion of the first ins rep I spoke to - didn't make a difference ... ) They kept telling me that they have 30 days to respond to an appeal. So, my dr's office and I thought that meant we'd have an answer by August 31. Even the insurance reps I was speaking to were saying the 31st.. However we came to find out that it's 30 business days, not 30 calendar days, which would make it September 14th. I called today , not that I thought I'd get an answer, but you never know. Today they told me that they have to answer by the 7th. So with the 7th being Labor day, I should have an answer by the 8th. I've rescheduled the surgery for the 28th of this month in the hopes, again, that I'll be approved. So, I'll keep my fingers crossed that I get good news on Tuesday.

Pindoctor - so glad your approval came through in time for your procedure. Having to reschedule is a pain in the butt!

Jelly - I know someone who used ankle weights under her clothes when she went to weigh in. I work with her husband and he's brought it up several times. Talk about frustrating! Not something I want to hear. And, I think she's lost around 30 - 35 lbs and considers herself to be at her goal weight. Yep, annoying!

[TaRena 32]

Denied with a BMI of 52 with conditions!

I have First Health thru Cigna. I have never cried as much as I have in the last several weeks. They have told me that they will only approve if I can prove that I am endogenous. That I can't lose weight any other way. The whole reason I have a weight problem is because I have several problems with my feet. I was always underweight until the problems with the feet arose & I can't exercise without causing more pain. I have been taking very strong pain meds for years, meds for blood pressure, cholesterol, diabetes, neuropathy, swelling & inflammation. I have developed a tolerance to the pain meds but refuse the doctor's advice to increase the dosage because I am so afraid of them that I suffer often in pain. I truly feel I am slowly dieing. I started 2 months ago eating and drinking Protein, cut the carbs to nothing and a lot of salads with turkey. I ride the stationary bike and do resistant bands. I have gained 1 lb!!! I then requested my doc write a prescription for a weight loss med...Cigna denied coverage for it. Received a different prescription for weight loss...again denied. I can't even get a list of covered meds from these jokers so that I can ask for one they cover. My husband's employer is contracted with the federal government and they switched to Cigna 2 years ago. I have had several surgeries on my feet plus other surgeries not related to my feet and have NEVER had issues such as I have had with Cigna. Luckily their contract is up in June and a new contractor will be hired. Hopefully they have better insurance. In the meantime I will proceed with trying to prove that my situation is endogenous. I applaud those of you who don't loose their cool & sanity through the approval process.

[Sharon1964 2,530]

They have told me that they will only approve if I can prove that I am endogenous. That I can't lose weight any other way.

If you haven't done so already, get a copy of their medical policy on bariatric surgery, in writing. If those statements don't appear, you have an excellent case to be overturned on appeal. The person reviewing your case can't just make things up on the fly.

If you meet every criteria in the published medical policy, and you need help constructing a good appeal letter, just give me a holler.