JennAsVSG

Well - I was supposed to have an 'in lab' sleep study done (as per the agreement from my insurance company and surgeon during my peer to peer) - well it of course needed a prior authorization - which was denied - the insurance company said to do the 'at home' sleep study first then if I "qualify" for the in lab study (meaning I fail the at home test) - then we would have to do the in lab test - got the order from my MD sent over for the 'at home' test - again needs a prior authorization - again denied.....

I am SO angry with insurance - I pay all this money for private insurance and NEVER use it - and when I finally want to utilize the insurance that I pay for - it's denial after denial after denial....

Of course I can pay (yet again) out of pocket for another test - but how much more should I have to pay for?? I've paid out of pocket for my 6 NUT appointments, my psyche eval; my endoscopy; my consultation - and now a sleep study - that I may or may not pass, and if I don't fail it (meaning don't have sleep apnea) my insurance WILL NOT pay for my surgery anyway - so it'll just be more money that's I've thrown out the window for this process - only not to be able to get it....

And then I keep thinking - maybe it's just not 'meant for me to have this surgery' because if it was - things should just kinda move along smoothly - or at least not having every proverbial door slammed in your face -

So what choices do I have now - gain 15 pounds so I can say poop on you insurance company - my BMI is 40 - or do I try - yet again - to 'get serious' with better eating habits - using some of the lessons that I've learned from my NUT appointments - and continuing with the exercise goals that I made during my NUT appointments....gaining 15 pounds is harder than you'd think - and I'm already uncomfortable in my skin, so adding 15 more pounds I don't think would do me any good - emotionally, physically, or mentally - so I guess it's going to be 'getting serious' - again - and hoping that this IS the time that sticks.

Best of luck to all of you going through your process for WLS.

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Anyone get denied by cigna because of mental health notes? Or any reason? Did you later get approved? So very anxious. This has been a very long journey for me and then to get denied I was heart broken but am hopeful mydoctor's peer to peer with ins. Will do the trick.

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I have independence blue cross - my initial submission was denied I feel your pain and devastation - had my peer to peer last week - my surgeon convinced the insurance MD to approve my VSG if I have sleep apnea - so now I'm scheduled for a sleep study - so I have riding on ONE nights sleep!! Don't give up hope - I haven't

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Thanks for the ray of hope!!! I will for sure let you know how it goes

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Next hoop - need a sleep study - scheduled for 07-18 - so much riding on one nights sleep

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Yes it was accepted. Insurance has approved now just waiting for Dr to get back with me to schedule!!

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Hey - I'm in this 'trying to get approved' dance that I'm hoping will end soon just spoke with my insurance coordinator and after my peer to peer today - the insurance company said they would approve my surgery if my sleep study indicated it - so now I'm scheduled for a sleep study - my BMI is 36.3 and I do snore but I'm so worried that I WILL PASS my sleep study - it's the only time I've prayed to fail something did you know you had 'sleep apnea' before you submitted?

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Hi everyone. I have been considering this surgery for a number of years, and the time has never been right. When I started to seriously consider it, it was prior to having kids. I was already facing some fertility issues (thanks to my weight and PCOS), and knew that I didn't want to delay starting a family further in order to have the surgery. I was heavier then, and probably would have qualified easily, as I'm assuming my BMI was close to if not over 40. Fast forward 7 years, and I have 2 kids and I'm ready to get my life back.

My BMI is 35, but I do not have any comorbidities. I made an appointment at a Bariatric clinic that was recommended by a few friends who went through it. They know my weight/height and I did advise I don't have high blood pressure, diabetes, etc.. My thought and hope is that they scheduled the appointment because they still feel I'm a candidate. I'm not sure how that works, though. Per my insurance (Aetna), I have to be at a BMI of 35 with another weight related issue in order to be covered.

Does anyone have experience with centers like this and Aetna? Are they willing to work with your insurance in order to get covered? Or is it pretty much a hard and fast rule, and the doctors can't do anything to override it? I cannot pay for this out of pocket, so I'm praying that this all works out. My appointment is July 16.

Any advice or experience?

Hey - I don't have any experience or advice - I'm kinda in the same boat - I have jumped through all the hoops - paid all the co-pays - had the required testing done (that I paid for out of pocket) - have submitted to insurance and was denied - awaiting the verdict of my peer to peer - my BMI is 36.3 and my comorbidities are GERD and Hyperlipidemia - hoping for good news.

Not sure if your July 16 is an information/consultation meeting - maybe they will be able to give you more info or 'find' a comorbidity that you didn't even know you had

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Sorry to hear that hoping you can find another way!

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So I found out about 2 weeks ago that my insurance denied me because my BMI was not greater than 40 and the comorbidities that I submitted (GERD and Hyperlipidemia) they didn't consider obesity related - my BMI is 36.3 - and no I don't have hypertension or diabetes (although I do have an impaired fasting glucose which my MD says if I don't loose weight I WILL become diabetic) - but really - do you want me to 'be sick' first - what about trying to prevent these diseases?!?!?!

So I'm wondering if there are any success stories out there with any of you who have been denied upon initial submission of your paperwork - only to be approved with a peer-to-peer - looking for a ray of hope

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@@JennAsVSG

If you already have GERD why are you getting the sleeve? Is your GERD hiatal hernia related?

@@OutsideMatchInside - no not related to hiatal hernia or anything structural like Barrett's Esophagus, more than likely weight related - that's why my surgeon likes to do an endoscopy on every WLS patient to see if there is anything that needs corrected (hiatal hernia) or would cause a WLS procedure (VSG) to be contraindicated (Barrett's Esophagus)

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Wow. That really sucks. I'm worried that they may deny me, too. I go for my last weigh in July 1st. My MD keeps asking me if I'm sure my BMI is high enough to need surgery. (I think I'm around 37)

My insurance requires a 6 month medically supervised weight loss effort and 2 co-morbidities. I'm like you and on my last stages. Had to pay out of pocket for psych evaluation as well as other things that my insurance would not cover.

I've read on here where some have submitted an appeal...have you thought of doing that?

My insurance required the psyche eval, 3 months of nutritional appointments, weight loss/diet history - I paid out of pocket for my ALL of it so far - if they do not approve it after the peer to peer with my surgeon I will look into filing my own appeal

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Hi - I'm new to this WLS community and I could really use some encouragement right now

I just spoke with my surgery center to make sure they had all my paperwork and to see if they had submitted my information to my insurance company - and they did - and today my insurance company called them and said my surgery was DENIED because they didn't think my co-morbidities and BMI qualified me for the surgery to say I am disappointed is an understatement! My insurance coordinator at my surgery center did say she has already sent a message to my surgeon (he's on vacation this week and will not be back until Monday) and that he will more than likely call my insurance company for a peer-to-peer review - she said she would call me next week with an update

A little info about me: I started considering this surgery last year and began actively pursuing it in January - going to an info seminar, choosing a surgeon, starting my NUT appointments (insurance required 3 - I'm on my 4th), did my psyche eval, my endoscopy, and had my medical clearance - I even have a 'tentative' surgery date of 09-08-16. My BMI is 36.3 and I have hyperlipidemia and GERD as my co-morbidities - I really did NOT think I would be denied - my surgeon said I was the 'ideal' candidate because I didn't have an over abundant amount of weight to loose and I wasn't 'sick' with diabetes, hypertension, or anything like that yet - I'm just super bummed

Has anyone had their insurance company deny them only to approve them after speaking with their surgeon?

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