Jump to content
×
Are you looking for the BariatricPal Store? Go now!
$99 Yearly Supply Alert! 🌈 "1 per Day!" Bariatric Multivitamins

Denied :(

ShineBright724

Recommended Posts

ShineBright724    70

ShineBright724
Posted

Just got my letter from my insurance and I was denied! What do I do next? I'm crushed.

Share this post

Link to post
Share on other sites

Crkrjax76    76

Crkrjax76
Posted

Find out why you were denied. It could be something as simple as something didn't get turned into the insurance. Then you might have to file an appeal. I wish you luck!!!!!!!!!!!!1

Share this post

Link to post
Share on other sites

liane    30

liane
Posted

Oh no! I am waiting for approval as we speak. My surgery date is the 15th. When i spoke to my insurance company Friday they said if I was denied a reason why would be included. I am just hoping and praying it is not denied. I will hope for you that it is something simple and you will be approved in the near future!! :)

Share this post

Link to post
Share on other sites

Sparklette    381

Sparklette
Posted

Call them and ask why, I could just be a paper work issue. Appeal, have your surgeon and pcp give your insurance a letter of medical necessity.

You journey isn't over because you hit this bump.

Share this post

Link to post
Share on other sites

ShineBright724    70

ShineBright724
Posted

The letter said I failed to prove that I failed non surgical weight loss methods. What have I been doing for 7 months?! I listed all the failed diets I've done...

Share this post

Link to post
Share on other sites

life_after_gastric_bypass    214

life_after_gastric_bypass
Posted

I would call back and find out if maybe you missed something or did they forget to send something...keeping u in prayers and fingers crossed :)

Share this post

Link to post
Share on other sites

SoccerMomma73    1,867

SoccerMomma73
Posted

Don't freak!!! (Easy to say, I know). There are so many things that can go wrong with the paperwork trail, talk to your program director tomorrow and call the insurance company too. It could be as easy as someone clicking A instead of B when entering your data.

Good luck!!! Fingers crossed for you!!!!

HW 312, pre-op (RNY) 255, current weight 202.6

Share this post

Link to post
Share on other sites

JustRick    8

JustRick
Posted

I too was denied a few weeks ago. I contacted my surgeon's office and asked them to help with the appeal. The had a peer to peer phone call and the insurance company reversed their decision and approved me in two weeks.

Turned out to be the doctors office failed to include all the pertinent documents.

All is good now August 21 is my surgery date....

Good Luck

Rick.

Share this post

Link to post
Share on other sites

MrsS    2

MrsS
Posted

Just got my letter from my insurance and I was denied! What do I do next? I'm crushed.

I'm so sorry to hear that but everyone is right there might have been something missing! I was denied twice before getting an approval. They kept saying I had not provided adequate proof that I tried to lose the weight and then they said my BMI wasn't sufficient even though I had the lap band and it failed and my BMI was well within the numbers. After my surgeon called the head of insurance they told me that if I hit a certain level they would approve me no questions so I had to do three more months of weight loss documentation. Sometimes they play these games just to prolong it. See if your insurance has a time limit to resubmit because sometimes that is a shorter time than appealing it. Good luck!!

Share this post

Link to post
Share on other sites

Band Mom 3    17

Band Mom 3
Posted

Just got my letter from my insurance and I was denied! What do I do next? I'm crushed.

Oh no! All of the previous posters are right-you should get on the phone tomorrow and have your dr.'s office start working on it right away. I am anxiously waiting to hear back from my insurance company...I will pray that your issue is resolved quickly and comes back approved!

Share this post

Link to post
Share on other sites

liane    30

liane
Posted

For those that were denied...did anyone have BCBS? I am waiting for approval and wondering if I should be worried... Good luck with the phone calls!! Take care :)

Share this post

Link to post
Share on other sites

ShineBright724    70

ShineBright724
Posted

Thank you everyone! I'm going to call my surgeons office tomorrow and see what the next steps are. I have BCBS/Blue Care Network..

Share this post

Link to post
Share on other sites

Band Mom 3    17

Band Mom 3
Posted

For those that were denied...did anyone have BCBS? I am waiting for approval and wondering if I should be worried... Good luck with the phone calls!! Take care :)

Ugh! I have BCBS too.

Share this post

Link to post
Share on other sites

ShineBright724    70

ShineBright724
Posted

Well I was told that BCBS isn't too picky. I'm hoping it was lack of paperwork or something for me. Good luck!!

Band Mom 3 reacted to this

Share this post

Link to post
Share on other sites

MrsS    2

MrsS
Posted

For those that were denied...did anyone have BCBS? I am waiting for approval and wondering if I should be worried... Good luck with the phone calls!! Take care :)

I have BC/BS but after the first denial they gave me approval. I feel like they do that just to make sure you really want it.

Share this post

Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

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

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • 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.
    • BeanitoDiego

      BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
      · 0 replies
      1. This update has no replies.

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    Bariatric Forums

    For Patients

    Health Professionals

    Search Surgeons

    Bariatric Surgeons: Want to research a weight loss surgery surgeon? Enter their last name below to start!

    ×