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So I Got Denied Today

DreamsOfSkinny

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DreamsOfSkinny    53

DreamsOfSkinny
Posted

So I called again and got ref. number for call stating that I only need 1 co-morbidity and bmi of 35+ for past 5 yrs although the medical Dir. Of Ins. Said I was denied bc I didnt have bmi of 40+. Second issue the insurance chose 2 of my lowest weights for 2 yrs and didnt even mark down for a whole year EVEN THOUGH my dr. Submitted all health documents! I talked to my ins. Coordinator at Dr office today

And she said the insurance is just trying to find anything to not approve me. The Med. Dir. Called their office for a peer to peer at lunch time and left a message with the answering service. When my ins. Coordinator called back the ins. Said the peer to peer was already done. She was livid when i talked to her today. Coordinator said she scheduled it for Thursday an gave the Dr's cell phone to make sure they are reached this time. I am really not hopeful at this point and it'll probably go to an appeal but the coordinator said theres no reason they shouldn't approve me by their criteria bc I meet it all. So I'm just praying! I do have a a follow up appt with my surgeon this Friday which we were hoping to use as pre op so I guess if it gets approved I'll be ecstatic as I'll have pre op appt done and can schedule!!! Prayersssssss

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MrsBenson    29

MrsBenson
Posted

My insurance coordinator said the same thing. That they are trying to find any excuse not to approve me. I finally got approved. It was an 11 month process but I've heard people going through it for 3 years before being approved. So don't give up!

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DreamsOfSkinny    53

DreamsOfSkinny
Posted

My insurance coordinator said the same thing. That they are trying to find any excuse not to approve me. I finally got approved. It was an 11 month process but I've heard people going through it for 3 years before being approved. So don't give up!

Omg!! 11 months! I think I'd pay OOP lol not patient at all

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MrsBenson    29

MrsBenson
Posted

Well in order for my insurance to pay I had to do a nine month supervised diet. Then I got a few denials for little stuff.

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rxtine    20

rxtine
Posted

Well in order for my insurance to pay I had to do a nine month supervised diet. Then I got a few denials for little stuff.

What were the little things you were denied for? I start my 90 pre op nut visits next week!

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DreamsOfSkinny    53

DreamsOfSkinny
Posted

Well in order for my insurance to pay I had to do a nine month supervised diet. Then I got a few denials for little stuff.

Wow! 9 months is a long time.

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MrsBenson    29

MrsBenson
Posted

Well first because they said I had no Co morbids. So my doctor had to write basically why I needed it. Example ... if she doesn't have this she is at risk for diebeties, HBO, cholesterol, ect.) And my insurance coordinator wrote that my insurance covers it with no comorbids as long as my bmi is over 40. Then I got another denial saying I needed my regular pyscologist to give me a clearance even though I already got a clearance from the psychologist THEY wanted me to see. Then I got denied saying I needed a Pulmonary clearance. That took a little more time cuz I had to use a cpap for two weeks cuz they saw I had sleep apnea(minor case) then finally was approved.

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MrsBenson    29

MrsBenson
Posted

And yea it was long but. Less than a year of work and now I get the surgery completely free to me. I could never afford this on my own.

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DreamsOfSkinny    53

DreamsOfSkinny
Posted

And yea it was long but. Less than a year of work and now I get the surgery completely free to me. I could never afford this on my own.

Well if you get it 100% free that's great. I have $2k more for my OOP max but that includes any medical treatments me and my family have so the surgery may cost me like $1500 after any other tests I need.

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DreamsOfSkinny    53

DreamsOfSkinny
Posted

Well first because they said I had no Co morbids. So my doctor had to write basically why I needed it. Example ... if she doesn't have this she is at risk for diebeties' date=' HBO, cholesterol, ect.) And my insurance coordinator wrote that my insurance covers it with no comorbids as long as my bmi is over 40. Then I got another denial saying I needed my regular pyscologist to give me a clearance even though I already got a clearance from the psychologist THEY wanted me to see. Then I got denied saying I needed a Pulmonary clearance. That took a little more time cuz I had to use a cpap for two weeks cuz they saw I had sleep apnea(minor case) then finally was approved.[/quote']

Congrats on getting approved!! You are inspiration for me to not give up just yet.

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MrsBenson    29

MrsBenson
Posted

I just got the call today and am scheduled for January 7th! I have to be there at 11:00am! The bad thing is Ill b on a 2wk diet and I can't drink on new years. But its worth it!!!! 7 weeks to go. And yea its 100% free.

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mike010906    14

mike010906
Posted

I just got the call today and am scheduled for January 7th! I have to be there at 11:00am! The bad thing is Ill b on a 2wk diet and I can't drink on new years. But its worth it!!!! 7 weeks to go. And yea its 100% free.

Good for you!!! I know you are ecstatic as you should be!!! I was denied because I needed (cardiac and) pulmonary clearance as well. My info was resubmitted to the insurance onTuesday. Now I'm patiently waiting for a yay or nay :-/

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Piplula    709

Piplula
Posted

Good luck and don't give up..mine took 8 months for approval! Glad to stuck with it!

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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    • KeeWee

      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

      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

      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.
    • BeanitoDiego

      BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
      · 0 replies
      1. This update has no replies.
    • ChunkCat

      ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
      · 0 replies
      1. This update has no replies.

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