Jump to content
×
Are you looking for the BariatricPal Store? Go now!

upset...insurance denied



Recommended Posts

Hi..I'm so upset and frustrated. I did my 6 months supervised diet and everything...my paperwork went in first of may and insurance denied Romney the 15th. Said I didn't do a doctor supervised diet. I met with my doc...she approved and then I met with a team.nurse..nutritionist ..pt...for 6 months. My doc called and did a peer to peer review with insurance yesterday and they denied again.. my doc said I can start over...meet her and the team once a month for six months... ughhh...I can not take that much time off work again for the next 6 months. I'm really sad...I so need this....sorry for whining

I don't really understand why you have to meet with the nut team. For my doctors supervised visits, I just went in, got weighed and talked to my doctor for a few minutes. The entire visit may have lasted 5 or 6 minutes. The time waiting to see the doc was what boosted the visit to 30 minutes, easily done over a lunch hour. Also, make sure the doctor is using the correct forms, that was one of the reasons for my initial denial. They apparently couldn't accept just a written letter from my doctor, the information had to be on their forms.

Share this post


Link to post
Share on other sites

Thanks. I'm going to see if I can get time off work to restart this...maybe see if I can find a doc closer to work. Or..I might look into taking a loan...because one of the new insurance things is that if I loose any weight during that 6 month period they have the right to deny it.

Share this post


Link to post
Share on other sites

Thanks. I'm going to see if I can get time off work to restart this...maybe see if I can find a doc closer to work. Or..I might look into taking a loan...because one of the new insurance things is that if I loose any weight during that 6 month period they have the right to deny it.

That is how my insurance is. If I lost any weight it was considered a success and they would therefore not cover my lapband.

Sent from my iPad using LapBandTalk

Share this post


Link to post
Share on other sites

Did you end up paying on your own?

Share this post


Link to post
Share on other sites

I have BCBS...I live in Idaho..

Share this post


Link to post
Share on other sites

I have BCBS of AZ. I did end up doing self pay.

Sent from my iPad using LapBandTalk

Share this post


Link to post
Share on other sites

I also had a hiatal hernia so my insurance covered that repair (and consequently the anesthesia for the band).

Sent from my iPad using LapBandTalk

Share this post


Link to post
Share on other sites

I have Anthem BCBS of Michigan. My surgeon turned in all my paperwork and my PCP gave them a letter if necessity and they approved my surgery and 12 fills 3 days later. I have. BMI of 40 with 2 co morbidities. Surgery tomorrow. I would call who ever was your case worker at BCBS and find out why they denied it.

Share this post


Link to post
Share on other sites

You must also remember it has to so with negotiated benefits that the company you (or your spouse) work for set.

Share this post


Link to post
Share on other sites

I have BCBS. I'm not impressed...with how they are handling this. I could understand if I was not very much overweight...but I'm 150 pounds overweight..and have been for years...

So, my nurse at work here wants me to restart the program - go meet with the doctor, nutrionist and physical therapist...she said if I lose weight and don't need the lap band that that is great - that is the goal. I panic at that thought...because I know I can (or i did 3 years ago)...I lost 50 lbs...it's under that that I can not seem to get.

Share this post


Link to post
Share on other sites

so, I met with my doctor to start with and told her I wanted the lap band. She referred me to the"WLS diet program", where I met with the nurse, nutrionist and physcial therapist. The nurse kept my doc informed of my progress. The insurance is saying that I should have met with my doc each one of those months so they are not counting it as a "dr supervised" diet.

Share this post


Link to post
Share on other sites

Mama Angela- I call my BCBS as soon as I made the decision to see what their requirement were. Every insurance is different and we can't expect the surgeons office to know the specific requirements for every insurance carrier. One thing I have definitely learned when it comes to elective surgery is to be pro active and take matters into my own hands. This is my journey and I wanted to be in control of it from the beginning. BCBS was great to work with, I especially like my nurse advocate. Call your insurance and ask the questions you need to know. I wish you all the best on you journey!

Share this post


Link to post
Share on other sites

This thread is making me so nervous! My surgeons office has me meet with a physicians assistant every month of my 6 month supervised through insurance - and I only met my surgeon in person 1 time. I hope this doesn't effect my approval as well :-( my last appt with the PA is this week... :-/

Share this post


Link to post
Share on other sites

Connie don't be worried call your insurance carrier and verify what you have done and what still needs to be done. It will be fine. Best wishes

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Eve411

      April Surgery
      Am I the only struggling to get weight down. I started with weight of 297 and now im 280 but seem to not lose more weight. My nutrtionist told me not to worry about the pounds because I might still be losing inches. However, I do not really see much of a difference is this happen to any of you, if so any tips?
      Thanks
      · 0 replies
      1. This update has no replies.
    • Clueless_girl

      Well recovering from gallbladder removal was a lot like recovering from the modified duodenal switch surgery, twice in 4 months yay 🥳😭. I'm having to battle cravings for everything i shouldn't have, on top of trying to figure out what happens after i eat something. Sigh, let me fast forward a couple of months when everyday isn't a constant battle and i can function like a normal person again! 😞
      · 0 replies
      1. This update has no replies.
    • KeeWee

      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
      · 0 replies
      1. This update has no replies.
    • Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×