What? Denied? Why?

[Luckyinluv 30]

I so frustrated!! Paper work sent Monday called insurance Tuesday not in system. Called Wednesday it was pending. Called today...denied! But the insurance gal said I was denied Monday! How can it be pending after it was denied? She said didn't your dr. Call you with the reason why it wasn't medical necessary

? Of course I said no. Called my dr and of course they were closed! Why oh why can't it work put?

[jtickle 295]

I am sorry you were denied. Can you appeal?

[ChristyAZ 87]

I am so sorry ..... don't give up though ....... fight ....... for your future and your present ........ I know I have read a few posts about a advocate group that (for a fee) helps you fight and appeal ..... maybe someone can post the name of that company? Good luck to you ......

[Luckyinluv 30]

As of now I don't know why I was denied. Insurance on said not medically necessary. I will talk with my dr. Tommarow. For peets sake my BMI is 42. I did three months of weight checks via 90 days. I have HBP, acid reflux. Wishing for that rainbow!

[cutiepieinchi 158]

Please don't give up hope! Maybe they forgot to submit a portion of your paperwork.

[jodie1961 77]

I shared a bit ago...I was approved for band removal and denied for revision to bypass..after a long wait, and etc..found out I could request a peer to peer review (my doc to speak w/the insurance doc)

after that they (ins) said I could appeal. I was approved after the peer to peer...didn't even have to go thru the appeal process. I was denied because they said "not medically necessary" Thank goodness I spoke with a supervisor at the insurance before doing the appeal. See if you can do this. Worth a shot! Best of luck.

[Luckyinluv 30]

After talking with insurance and my dr. I have found out the I had 35 pages of why I need this surgery. Insurance says none of my clinical papers were there but my dr. Called and made sure they were and so the supervisor is reviewing it herself. My dr thinks they just didn't want to look at all 35 pages and told me this has been happening too often. So I call back next week. Praying hard and trusting The Lord!!

[cherrybomb420 1]

I'm on Medicaid ,does anyone know if its hard to get approved through them?

Edited May 1, 2014 by cherrybomb420

[jodie1961 77]

LuckyinLove...have you heard anything yet? I go to see the surgeon tomorrow. They said it would be a few hours all together. See the nutritionist about pre-op diet and post of diet, etc. Should get my date for surgery too. Hope you have gotten some answers by now. Hang in there, thinking of you and praying for a good outcome.

[Luckyinluv 30]

<p>LuckyinLove...have you heard anything yet? I go to see the surgeon tomorrow. They said it would be a few hours all together. See the nutritionist about pre-op diet and post of diet, etc. Should get my date for surgery too. Hope you have gotten some answers by now. Hang in there, thinking of you and praying for a good outcome.</p>

Oh thanks so much for asking! I called Dr again and I have a new gal that called me back cause other is on maternity leave. Sholanda is amazing!! She called me back and told me she is my advocate and will be calling insurance today and speak with the supervisor. She said they need to understand I did everything right and I pay my premiums. She will call me back this afternoon. I am trusting and praying!!

[Ginger Snaps 1,323]

@@Luckyinluv -- waiting to hear your good news! Wishing for the best outcome.

[Luckyinluv 30]

Update: my dr called this am and just told me all the insurance needs is a letter of medical clearance. My dr did a letter of reference but they want to to say cleared for surgery!! I might have a approval todAy!! I can't breathe!!

[jodie1961 77]

It is always helpful to have someone in your corner at the Drs office. Debbie was my angel at my office. They take on the insurance and follow through. Sad that insurance people let us slip thru the cracks. It is life or death in many of our situations, not just paper work to be lost! Praying that your "angel" will get you back on track real fast. I went today, met with the surgeon, and I can hardly believe it, I got a May 13th surgery date! I have to start my pre op liquids on Monday! Keep me posted.

[Luckyinluv 30]

Well I got my medical clearance letter faxed into insurance just like they asked for so I didn't hear a no! Lol so Hoping Monday I hear a yes!!! It really is life or death. I feel my body slowing down and I still have a 7 year old that keep me moving!!

[dhizzle339 3]

Luckinluv- it took 2-3 weeks of me calling the insurance company to get approved. I had a similar experience. I would call they would tell me it was pending. Then I would call again and get another answer or denied. I found it was helpful when I called to write down what I was told, by who, date and time, then ask when I should call back- even though I would call the next day. Don't be afraid to ask for someone higher up. I finally got the answers I needed and what was keeping me from approval. Good luck!