Well forum family I was denied. You can imagine the feeling I felt once I found out. No, I did not go on an eating spree but my feelings were very hurt. The program manager said that she was going to call me after the holiday weekend to see what we will do next, so I will keep you up dated. For one my insurance ends on 12-31-11 and my job will be picking up a new one on 1-1-12. They denied me over the craziest thing. They do cover it but am wondering if they denied me because of the end of the year issue, so that they do not have to pay for it, knowing that they will no longer have me at the end of the year. So I am not going to give up. I need this sleeve and I will continue to do everything I need to do in order to get it. Keep me in your thoughts...wanted to keep you updated...if anyone else has been deinied please share your experience. We are in this thing together. I am asking for all shoulders to lean on right now!! :cry_smile:

Hi,

I really feel bad for you. I was just denied yesterday and cried all night. Luckily, my surgeon got the decision overturned today and I will get my surgery this Friday (the surgery was supposed to be today, they told me that I was denied the day before the surgery). Please keep hope, I know you will get the surgery. I know exactly how you are feeling right now, it is the worst feeling to want something so bad and have your decision based upon someone else that doesn't even know you. If you need to talk just message me back. Again, keep the faith, I know you will get the surgery done!

Oh my what suspense over this holiday weekend. That is terrible.We work so hard at this and want it so bad...... I am really sorry. I hope your surgeon can get this overturned just like Twndr3. Big hug to you.

So sorry. The insurance companies can be such bullies! Keep fighting. My insurance company tried to deny me too. I fought and called them so much I think they got sick of me. I wish you the best in getting approved. Just know many of us have been denied and then gone on to get our sleeves.

What was their stated reason for denial? Insurance is in the business to make money and these surgeries are expensive....so yes they will look for ANY reason to deny it.

My first insurance company denied me twice and then my company switched insurance. The new company approved me in less than ten days and nothing had changed. It might be beneficial to have a new insurance company.

EnjoyWhoIAmBecoming I am so very sorry for you being denied. :sad_smile: You have every right to be sad and cry :cryin: for a while, only. You need all your strength to fight for your rights :fencing: And of course you are correct having the WLS , ins. co. doesn't realize how stupid they are, and they should look at the whole picture.

:seeya: Ins. Co. should approve all that are qualified for WLS. After all, the cost for the ins. company taking care of people with major issues like diabetes, high blood pressure, high cholesteral (msp), sleep apnea is more expensive over a life time than WLS costs them. Why can't they see that? Yes, WLS will make you look better, and feel better about yourself (which is really good). But that is secondary to all the health issues that WLS will cure, why can't they see that. :noidea:

Good wishes in your fight. I have confidence in you. :thumbup1:

kathy

i was denied twice before my approval, I was sleeved on 11\14, my best advice is to keep fighting & every time you send in new or updated information call every day! I figured, the squeaky wheel gets the grease so to speak LOL I knew i was approved before my surgeons office LOLOLOL

Good Luck!

G

I hate to hear things like this because it can really bring the person down. The best advice I can say is ask for help from your surgeon , they obviously have more pull (most of the time) than we do ourselves. In truth this is not the end of the world, and you will pull through. If this insurance company ends up denying you all the way to the end, the next one will prolly approve u no problem. Stay Strong and stay dedicated because you WILL have this surgery. Good Luck!

I'm soooo sorry y'all got denied! that's my worst fear right about now. My last PCP appointment is on Dec 9th and then off to the insurance.

Can y'all tell me why you got denied? I have BCBS federal and I'm VERY afraid they are going to give me crap about a simple little thing. :confused5:

Wow! So many people are lucky to have insurance that pays for this surgery. I hope yours does too.

I never had any chance of insurance paying

what insurance do you have and which insurance will be switching too?

I'm not sure if it is the same for all insurance companies but I have BCBS and I was told that the sleeve is only approved for patients with a BMI of 50 or higher

I really hope yu get approved

My insurance company is haggling right now because my initial weight in February (my first appointment) had me at a BMI of 49... and they say the sleeve is approved for 50 or higher. The thing is, I have gained weight and now have a BMI over 50, so they are really trying to push for the sleeve approval for me. Just a couple of pounds at my initial weigh-in should not be damning me to RNY (which they would approve with no problem... wtf?!?!?!)!!!

i was always told that you must have a BMI of at least 40, or at least 4 morbidies (msp) etc. sleep apnea, high blood pressure, high chloresterol (msp) and diabetes to name a few.

good luck

kathy

Generally it is BMI of 35+ with 2 comorbidities or BMI of 40 or higher with no comorbidities that will easily get you approved for the band of the bypass. The sleeve is tricky. Like I said my insurance says your BMI must be 50 or higher. I think that this is probably due to the fact that the sleeve was initially used as the first stage of the Duodenal Switch which was a surgery that was reserved for the super obese. This requirement may soon change since the sleeve is now becoming accepted a primary procedure for lower BMI patients.