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I Got A "no" From My Insurance Company

Well, I received the dreaded letter on Saturday from my insurance company telling me I do not qualify for the surgergy. I'm not fat and sick enough apparently. I don't thnk I have ever felt so sad in my life.

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  • chitowngirl
    chitowngirl

    I would call them and ask why. I got denied once and found out that I needed to do a more comprehensive 6 month diet. So I did it and I got approved the second time around.

  • 2BonederfulAgain
    2BonederfulAgain

    TRY TRY AGAIN...I know people who have gone back and forth with the company and finally got it! Sometimes it takes a week sometimes a few months but they get it.

  • If you care to share your requirements for pre-approval, and your personal stats (BMI, comorbs, etc.) we might be able to help you pontificate things you can use should you choose to appeal.

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BTW, I was denied on my first submission for a VSG revision (even though they had just approved my lapband removal). I appealed and was approved, but my insurance changed before we could schedule the surgery. So I had to start over from square 1. All in all from my band removal to my sleeve revision it took about 7 months. I was going to wait about 3 more weeks and if I didn't have an approval by then, was going to self pay. So in my case, patience (a little, anyway) and persistence saved me about $11k. Definitely hang in there...

Keep on swimming keep on swimming. Persist like the above poster said, you will eventually wear them down.

  • Author

Wheetsin, thank you for all the great suggestions! It had crossed my mind this morning that I could possibly get my Internist to maybe help me push on this since she was very supportive of me taking this path for help when I mentioned to her. And, of course she has the records of all my bloodwork, etc. We have been struggling for the past two years trying to find a cholesterol medication that would work for me which might could help too. The weight gain, in spite of multitudes of attemtpts to get it down, has been steadily going to up by 6-10 lbs every year. It's simply in my genes. My brother got sleeved last July and he just looks great and is so much happier, energetic, and healthy.

I have high bp ;and my "good cholesterol" is not good; sleep apnea and pre-diabetic; forgot - stage 3 kidney disease - I'm sure hoping this is enough. My BMI is 36 and I have 100 pounds to lose.

I am also your same weight and height. This is the 8th working day that ins. has had my information. I can't hardly stand the wait. I have BCBS and my surgeon's office says they have seen people with lower weight be approved. So I still have hope. I also have sleep apeana (sp?).

I have been calling my ins. co. I'm embarrassed to admit.

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