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Insurance Doesn't Cover, Submit Letter?

Wisdom2KnowTheDifference

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Wisdom2KnowTheDifference    32

Wisdom2KnowTheDifference
Posted

So I found out today that my insurance does not cover WLS, but I was told my doctor could submit a preauthorization letter which would be reviewed. Has anyone had any experience with this? Specifically trying to get Lap Band covered by an insurance company that is expressly saying they don't cover it?

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highland    168

highland
Posted

No luck here. My employer specifically excluded WLS so no matter whT my surgeon wrote, they denied me. It's upsetting because my i surance company has benefitted greatly from me losing 100+ pounds! I was tKi g massive amounts of insulin that was costing them $5000 per month. I know take 1/10 of that amount!!! By self paying for lapband they also will not cover anything related to it like a tt or panilectomy. I just had had a tt and br which I also paid for! With that said, I wish you all the luck in getting approved.

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kloee    1

kloee
Posted

I to was denied the first time, so i wrote a letter to appeal it also had a letter that my Dr. wrote up. Explaining that i had dieted and tried many diets in the past. Sent it in and got approved. I was not at the B.M.I. index that was necessary for the surgery but net the sleep apnea and high cholesterol and blood pressure.

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kloee    1

kloee
Posted

I also have the letters that i wrote to my ins. company if you would like them. I received them from a lady i met on this forum that was also denied. One is a personal plea, the other is explaining my medical side of it.

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xavtay2    85

xavtay2
Posted

Good luck on getting your approval. I just sent a certified packet today with my office letter of appeal to Cigna. I wish I would have had your letters. If you can please send them to my personal email: xavtay2@gmail.com. They still may come in handy, I was denied because of the facility my insurance does cover WLS. we will see the outcome as I am sending positive energy to everyone affected in this way. I believe that it will be apprived I just have to fight for it. Good luck and keep in touch

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NWgirl    574

NWgirl
Posted

Good luck on getting your approval. I just sent a certified packet today with my office letter of appeal to Cigna. I wish I would have had your letters. If you can please send them to my personal email: xavtay2@gmail.com. They still may come in handy, I was denied because of the facility my insurance does cover WLS. we will see the outcome as I am sending positive energy to everyone affected in this way. I believe that it will be apprived I just have to fight for it. Good luck and keep in touch

Some insurances require you to get surgery at a center of excellence. If this is what you mean by facility, I don't think they will approve a place that is not a center of excellence. Center of Excellence locations have extremely strict requirements which are set forth to ensure the best patient care and outcomes.

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xavtay2    85

xavtay2
Posted

Hey NW GIRL~

Thanks for your response and you are correct. The only problem is I was told by two different insurance precertification representatives that the listing of Center of Excellence hospitals they are using is outdated! To be exact one rep said October of 2011 and last week another lady told me it was dated back 2009. I jsut think they need to use a current listing prior to giving me a denial..

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NWgirl    574

NWgirl
Posted

Ooh, that is a problem!!! So the one you want to go to is a center of excellence but their records don't reflect?

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Bubie1916    59

Bubie1916
Posted

I also have the letters that i wrote to my ins. company if you would like them. I received them from a lady i met on this forum that was also denied. One is a personal plea, the other is explaining my medical side of it.

. How can I get a copy of your letter or sample to help write my insurance? I just got denied and want to appeal it. Can you help me?

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A_in_Jade    0

A_in_Jade
Posted

I also have the letters that i wrote to my ins. company if you would like them. I received them from a lady i met on this forum that was also denied. One is a personal plea' date=' the other is explaining my medical side of it.[/quote']

Id love them too! Can u send to my email? Message me!

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Bubie1916    59

Bubie1916
Posted

I also have the letters that i wrote to my ins. company if you would like them. I received them from a lady i met on this forum that was also denied. One is a personal plea, the other is explaining my medical side of it.

. Kloee, my emai address is: emat704@Verizon.net- I would really love to get copies of your letters, as I will be appealing. Thanks!!

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kloee    1

kloee
Posted

sent you a e mail

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chevy_truckin    0

chevy_truckin
Posted

Hi I am trying to get mine done I am looking for a good doctor real soon in ky and was wondering I you could send me a copy of those letters to be ready if they deny me since my work has it excluded

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Go To Topic Listing Insurance & Financing

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    • LeighaTR

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      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
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    • Doughgurl

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      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 2 replies
      1. Selina333

        Selina333

        I'm so happy for you! You are about to change your life. I was so glad to get the sleeve done in Dec. I didn't have feelings of regret overall. And I'm down almost 60 lbs. I do feel a little sad at restaurants. I can barely eat half a kid's meal. I get adults meals often because kid ones don't have the same offerings at times. Then I feel obligated to eat on that until it's gone and that can be days. So the restaurant thing isn't great for me. All the rest is fine by me! I love feeling full with very little. I do wish I could drink when eating. And will sip at the end. Just a strong habit to stop. But I'm working on it! You will do fine! Just keep focused on your desire to be different. Not better or worse. But different. I am happy both ways but my low back doesn't like me that heavy. So I listened (also my feet!). LOL! Update us on your journey! I'm not far from you. I'm in Houston. Good luck and I hope it all goes smoothly! Would love to see pics of the town you go to for this. I've never been there. Neat you will be traveling for this! Enjoy the journey. Take it one day at a time. Sometimes a few hours at a time. Follow all recommendations as best you can. 💗

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        Thank you so much for your well wishes. I am hoping that everything goes easy for me as well. We don't eat out much as it is, so it wont be too bad in that department. Thankfully. Also, I hear you regarding your back and feet!! I'd like to add knees to the list. Killing me as we speak! I'm only 5' so the weight has to go. Too short to carry all this weight. Menopause really did a doosey on me. (😶lol) My daughter also lives in Houston. with her Husband and my 5 grand-littles. I grew up in Beaumont, so I know Houston well, I will be sure to keep in touch and update you on my journey. I may need some advice in the future, or just motivation. Thank You so much for reaching out, I was hoping to connect with someone in the community. I really appreciate it. 💜

    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.

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