Denied 2 days BEFORE surgery! Help!

[luvmemore 0]

My sleeve surgery was scheduled for today, Wednesday, September 10th.

I started my process three months ago. Met with the doctor, went through all the necessary paperwork and doctor visits, etc. Everything had been cleared and ready to go, or so I thought.

I received a phone call from my doctor on Monday telling me that my insurance does not cover the surgery! MONDAY! Two days before I was scheduled to go in the hospital!! Needless to say I am absolutely devastated and depressed! The reason they are giving is that I have no health problems other than my excessive BMI. Even if this is their policy, the fact that my doctor is just now running my insurance through is insane to me! I have asked them for suggestions as to what I can do and they are not being the least bit helpful, so I turn to you all and ask if ANYONE has any advice on what can be done? I feel like I have been kicked in the gut at this point. I cannot stop crying and just feeling like all of my time, effort, and money have been wasted due to the doctor's office not following through on their part.

Please help.

Thanks.

[finediva 979]

I don't understand what happened here. I did all requirements, case was submitted to insurance company, I was approved, went to meet with surgeon AFTER approval received from insurance, doctor and I settled on surgery date and I was given pre op instructions. In that order. Did you believe you were approved? Did the office ever call and say you were approved? How long ago was your surgery scheduled?

[luvmemore 0]

I went to the weight loss doctor for my intital visit. On that day they let me know what to expect, i.e., doctor's visits, paperwork, etc.. They also gave me a surgery date which was three months out. They took all my insurance information. I have been to consultations before and the doctor always ran the insurance through to check for coverage. For the three months that followed, I did the necessary follow ups understanding that I was covered for this procedure. There was NO indication that I was not covered until they phoned me on yesterday. I would have never put out the time and money for all the doctor's visits had I known. Most importantly, I would have never set myself up for the heartbreak.

[Luvin_Life125 558]

I am so sorry. That is a hard blow when you are so close to and ready for a surgery you worked to get ready for. Hugs to you. It is time to use your frustration to find out what is going on. Your first step is to research your summary plan description from your insurer and your employer . This will give you a way to see the guidelines of your specific policy and what it says about bariatric surgery. Your next step is to go through the guidelines one by one and make sure you have met each requirement. If you have questions, please call your insurer customer service number on the back of your insurance card and ask every question you have. This is the only way to get to the answers you need. I know this set back is upsetting and you feel defeated. Please know we are here to support you. Please don't give up, be determined to find the answers you need. The denial may have been a mistake or may need to be appealed.

I also wonder why the doctor's office didn't check into things further before scheduling surgery. My docs office won't schedule my last pre op surgeon visit, nor start my pre-op diet, nor even give me even an estimated date it when my surgery might be scheduled until they have an approval letter in hand from my insurer. Different strokes for different folks, I guess.

Hang in there and find the answers you need!

[luvmemore 0]

My insurance is denying me based on not having any other health issues (high blood pressure, sleep apnea, etc.).

Thanks for your kind words. They mean a lot. I am trying to deal with it as best I can.

[Luvin_Life125 558]

What insurer do you have? A BMI over 40 alone isn't sufficient? Have you had a sleep study done recently? If you haven't had a recent sleep study done, it might be worthwhile to do it and see if you might have sleep apnea. It is very common among the obese and just might be the ticket you need. Is your surgeons office willing to appeal the denial or do a peer to peer review? It would be wise to pursue the appeal process and see if it can get you somewhere. If your surgeon's office won't do the appeal, I can help you write one if you want assistance. I worked for many years as a billing manager for al large medical practice and have written many, many appeals in my time. Hmm, I will see what else I can think of in the mean time to help out.

[Miss Mac 6,261]

Here is a list of co-morbidities that most insurance companies recognize when considering eligibility for weight loss surgery. I would never hope for someone to be ill, but would you possibly have anything on this list??????

It is just unreal that your bariatric team waited until now to check your coverage. Will your insurance be paying for all of your pre-op requirements and appointments, or are you stuck with paying for those? I agree with everything Luvin_Life125 is saying. I wish you good luck and good health.

In the meantime, the best you can do is what you have learned so far about nutrition:

1. Eat Protein and plenty of it.

2. Drink Water until your eyeballs float.

3. Pretend like carbs cost you $10 cash apiece-up front!

4. Eat more non-starchy veggies and less fruit.

5. Truthfully track what you are eating. If you do not track, you will lose track.

6. If you are not physically able to do much exercise, at least get up once an hour and move around for a few minutes. And I think doctors still agree that the best exercise there is, is walking.

Obesity Comorbidities

To follow is a list of comorbidities (additional conditions or diseases) related to obesity which may help you in qualifying for weight loss surgery.

• Family history of heart disease
• Family history of stroke
• Family history of diabetes
• Family history of heart attacks
• Hyperinsulinemia
• Diabetes
• High blood pressure
• Coronary-artery disease
• Hypertension
• Migraines or headaches directly related to obesity or cranial hypertension
• Congestive heart failure
• Neoplasia
• Dyslipidemia
• Anemia
• Gallbladder disease
• Osteoarthritis
• Degenerative arthritis
• Degenerative disc
• Degenerative joint disease
• Recommended joint replacement from specialist
• Accelerated degenerative joint disease
• Asthma
• Repeated pneumonia
• Repeated pleurisy
• Repeated bronchitis
• Lung restriction
• Gastroesophageal reflex (GERD)
• Excess facial & body hair (Hirsutism)
• Rashes
• Chronic skin infections
• Excess sweating
• Frequent yeast infections
• Urinary stress incontinence
• Menstrual irregularity
• Hormonal abnormalities
• Polycystic ovaries
• Infertility
• Carcinoma (breast, colon, uterine cancer)
• sleep apnea
• Pseudotumor cerebri
• Depression
• Psychological/sexual dysfunction
• Social discrimination
• Premature death in the immediate family
  

[Jersrose43 837]

Have you called your insurance? I will call them directly and find out what happened and get the correct insurance requirements. Once you know you've met those call the office and find out where they went wrong.

Advocate for yourself ! No one will do it for you.

[Jersrose43 837]

By the way what are your stats? Are you over a 40 bmi?

[vsgchick 117]

So sorry...very irresponsible on their part. I received a print out of my insurance requirements/coverage after the first initial consultation. Why in the world would they let you go through the insurance hoops without verifying coverage? Ridiculous. I hope you find a solution soon...keep us posted.

[cherie74 9]

I am so sorry. Hugs and I sure hope you get approved.

[robga999 129]

I know how you are feeling.it happened to me.i went thru everything and 2 weeks before my surgery I was denied.they said my sleep apnea wasn't bad enough because iop breathing enough times when I slept!you would think if you stopped breathing once it would be enough!!anyway I had quit smoking right after my first consul and I gained 10lbs so when I redid the sleep test and went from mild to severe and I was approved yesterday!its been a roller coaster ride this past few weeks waiting for muer.im scheduled for oct 6.my advice to you is appeal and redo some tests.