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Awaiting the results of the peer to peer meeting

star21nd

By star21nd, in Insurance & Financing

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star21nd    34

star21nd
Posted

I started my journey in Oct 2013 and got all my pre-op things done, did 3 months of diet. Summited in January and was denied because they would not except the weight-ins I did for those 3 months. (didn't state diet and exercise and wasn't detailed enough for them) So I started all over again with a 3 month program with a special dr that does the nutrition for people gearing up for wls. It was resubmitted but my insurance called my surgeon and said they wanted to do a peer to peer. Than was done yesterday and the medical director said he would have his descision within a week....Im tried to stay positive but I am a nervous wreak!

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SherB    220

SherB
Posted (edited)

Hello,

What is a peer to peer? What insurance company do you have? I hope it all works out for you.

Edited by SherB

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star21nd    34

star21nd
Posted

I have Cigna insurance and a peer to peer is when the Medical Director for the insurance company has a phone interview with the surgeon to get all fact and info to review...I guess it's a good thing because they can't come back and say missing paperwork because Dr gave them everything.

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SherB    220

SherB
Posted

Right,

I am sure the insurance company is a "peer" of your surgeons. LOL Hoops, hoops and more hoops. You would think your bmi might be enough? They just sent in my paperwork yesterday. I have United Health but you never know if they will have hoops of their own. Again..I hope for the best for you and that you get an "APPROVED" very soon!

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star21nd    34

star21nd
Posted

I know right, lol. I hope that you get approved the first go and that you don't have any hoops to jump through...This has been one of the most stressful experiences in my life but hopefully in the end it will all be worth it!

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JacobsMommy    27

JacobsMommy
Posted

We know all about this foolishness don't we?! Best wishes, keep us posted

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Jersrose43    837

Jersrose43
Posted

I started my journey in Oct 2013 and got all my pre-op things done, did 3 months of diet. Summited in January and was denied because they would not except the weight-ins I did for those 3 months. (didn't state diet and exercise and wasn't detailed enough for them) So I started all over again with a 3 month program with a special dr that does the nutrition for people gearing up for wls. It was resubmitted but my insurance called my surgeon and said they wanted to do a peer to peer. Than was done yesterday and the medical director said he would have his descision within a week....Im tried to stay positive but I am a nervous wreak!

You should have this back by now. Hope you got approved!

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star21nd    34

star21nd
Posted

I DID!!! Yay....the medical director took his whole week + some but I did get the call from my surgeon that I was approved. I start pre-op May 30th and Surgery is schedule for June 18th. OMG I am so excited and ready to open a new chapter on my journey. Also doing a modified diet to prepare myself for the pre-op diet. Thanks!

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Jersrose43    837

Jersrose43
Posted

That's exactly what I started doing. Modified the diet now to prepare. It's been an ok two days ;)

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star21nd    34

star21nd
Posted

LOL too funny.. I've only been very serious and tracking all food ect..for 2 days as well! But have been very mindful for the last 3 months since started good diet classes and meeting with nut

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Go To Topic Listing Insurance & Financing

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