Post Ops: Have You Ever Got Denied Approval Because You Had No Comorbidities But Where In The Weight Range?

[Kiki Von Moonshine 53]

So now that my H Pylori is cleared and its time to submit today, NOW the admin person that submits the paperwork calls and tells me that I might not get approved because my insurance is a difficult insurance and I have no comorbidities . Mind you this is month six, my clearance letter with all my stats was handed to her since the 5th of this month. Keep in mind I am 150lbs heavier than my ideal weight. She had at least two in a half weeks to look at my file and see if I did or didnt and if that would matter. Keep in mind I qualified according to the documentation they gave me six months ago. There was nothing indicating anything else. So if I was 500 lbs with no comorbiditiies I still might not be able to get approved?! WTW?! So I called her back and told her/reminded her that I am prediabetic so she will add that in. I mean seriously?!

[UTGal99 327]

How is your overall cholesterol? I find it hard to believe you don't have some type of hyperlipidemia. Btw, tell them your joints hurt really bad - arthritis and joint pain due to excessive weight can be considered a co-morbitity by some insurances. Good Luck and keep us posted!

[Kiki Von Moonshine 53]

She rushed me off the phone. She asked if I had breathing problems, I said yes. Shh*t... I'm fat. I told her about my pre-diabeties. So she said she would add that in. I mean its like a week from my scheduled surgery and its now shes asking me this. OR seeing this? Im sure she can make it look nice to get some approval I mean damn. I told her that I can't walk as far compared to my former skinny self, so lets see. She rushed me off the phone the second time we spoke so I think she knows what do, or was eager to go home (it was near 4 pm.) I have no clue what my cholesterol is, I just took all my tests and she should see everything in her face if she is doing her job right, but based on everything now. I am uncertain of that.

[Kiki Von Moonshine 53]

If thats the case I'll tell her my whole body is hurting if I have too. Ugh.

[Back~To~Amy 307]

I'm not sure that your whole body hurting would be considered a comorbidity. However, I thought that insurance required a comorbidites if you were at a lower BMI. I would think that being 150 pounds overweight alone would be enough. Have you called your insurance to see what they tell you? You may not have any comorbidites now, but at 150 pounds overweight, you likely will soon. To me, the insurance would be saving money by not having to pay for medical expenses for issues you are certain to develop down the road. I hope they get everything straightened out soon and you get the approval you deserve.

[Kiki Von Moonshine 53]

No I have not called my insurance because the reps don't know anything. The last time I spoke to them, they told me it is covered if medically necessary and said the doctor will explain to me the requirements. I will see if I can get it in writing and mailed to me. There is nothing more I can do at this point. I might call tomorrow to see if I need to get something else from my doctor in writing, but I have followed all that was required to a t.

[Back~To~Amy 307]

Best of luck to you!

[Nikki613 120]

Myn insurance coordinators told me when I was submitted that Cigna is by far one of the most difficult and I may be denied initially but not to worry. They were right!

I was denied but then approved after a reconsideration. Took about 19 days. I am scheduled for surgery in one month.

I am sooooo glad she didnt tell me until after I had been through the process, I would have given up and not comtinued had I felt there was a chance I would be denied!

I hope you get a Speedy approval and we are both on the losers bench soon!

[Kiki Von Moonshine 53]

I would have preferred knowing at the beginning so I would be prepared. I also would have did things different, perhaps have my doctor enter additional stuff on my clearance in BOLD. Oh well glad it didnt take to long. What did you have to do to win your case?

[Nikki613 120]

My expierience was a nightmare. I called to check the status every couple days and got a different story each time. paperwork was in the wrong department, then it was in the right one, then it wasnt. They had everything they needed then they didnt. I was so confused. Then they denied me saying they didnt receive the clearance letter / second opinion. Honestly i think that was BS. I had three different opinions I only needed two. Then my coordinator refaxed and they said I would know in 2 days. I kept calling every two days, they kept telling me 2 more days. Eventually a week later they told me I was approved. They told my coordinstor I wasnt approved.

this went on for a few days then finally my coordinator got the faced approval.