Has anyone experienced WLS denial even when you meet the insurance requirements i.e. bmi, supervised diet, test?

It didn't even matter what I did. There is a rider in my insurance that says no bariatric surgery will be covered at all!

So, we cash in a retirement fund and hope ins covers lab work, psych consult, things that can be attributed to other medical needs and go from there!

I'm talking about if your insurance company covers it and you meet all the requirements that they ask for but they still deny you.

It didn't even matter what I did. There is a rider in my insurance that says no bariatric surgery will be covered at all!

So' date=' we cash in a retirement fund and hope ins covers lab work, psych consult, things that can be attributed to other medical needs and go from there![/quote']

I have the same rider they will not cover. I am just glad I started this journey on my own. I have found out in the past 3 wks I have / had already or getting treatment..h pylori, sleep apnea and finally one this week that the EKG shows a recent mild (silent) heart attack ...so scary. So as long as I can start a new beginning very soon I am ok with paying for the surgery. .

I did not have that problem. I think I have seen previous posts talking about the steps if you are denied. Try searching "denial" and see what comes up.

Is there a particular reason you think you will be denied?

I've never heard of this but I have the same fear. I read on here one girl got denied from her surgeons office forgetting to send pcp referral. I am extra paranoid so I literally go to all my appointments with the same folder and get copies of my clearances THEN I call my surgeons ooffice to make sure they got it. Just be prepared we came too far to get denied! !!!!

There is not a particular reason why I should get denied. I called BCBS and they said that even though you met their requirements doesn't mean you will be approved. I was just wondering if this has happened to anyone before. Just like everyone else, this has been a long road and if BCBS did try to pull something like this, I would be so upset .

There is not a particular reason why I should get denied. I called BCBS and they said that even though you met their requirements doesn't mean you will be approved. I was just wondering if this has happened to anyone before. Just like everyone else, this has been a long road and if BCBS did try to pull something like this, I would be so upset .

sorry but BCBS sounds dumb. y would you get denied if you meet all the requirements??? good luck to you i'm sure you will be fine. also ive read a ton of people here have the same BCBS (not sure if depends on the state) maybe reach out and see if any of them heard the same

Yeah, it is dumb if what they told me was true. I'll reach out to others on here to see if they had this problem. Thanks.

That is good that there isn't a reason that you should be denied. I had just wondered if they had given you the idea it might be denied. I have BCBS Federal and they seemed pretty easy to deal with. If you have a good coordinator at your dr office they should be able to handle any hiccups that come up.

I think they have to say that nothing is guaranteed. I only met the BMI requirement as I didn't have any other co-morbidities. I know it would be upsetting to come so far & be turned down.

When they submit your things...just call the insurance company regularly to see where it is in the process...

I will be keeping my fingers crossed for you!!! Let us know how it goes!!

Ok, thanks

I learned from a dentist dealing with insurance companies that sometimes they will deny just to push the claim out into the future a bit, and they subsequently approve on re-submittal. The dentist's office said they had seen that a lot, so it stands to reason that scenario would apply to medical as well. Make sure your ducks are all in a row, and bug the crap out of them! Your surgeon should have an insurance advocate who can help as well.