Disappointed insurance denied

[Mz. NuNu 19]

So upset & hurt right now. For seven months, I have attended supervised weight loss classes, followed all guidelines from my nutrition & was looking forward to a healthier me. Only to be told that, since I have only had a BMI of 40 & above for 2 years with no co-mobs that I am not a good candidate. I am pre-hypertension & 100 plus pounds over weight.

[Ladiec2 74]

Sorry to hear that. Is it anything your doctor can do to appeal? I'm so worried that I'll end up in the same boat when my paperwork gets submitted. Hopefully something can be done or maybe consider going to Mexico. My twin sister's insurance doesn't cover the surgery so she's heading to Mexico next week. Hope things work out for you if they can appeal.

[Miss Mac 6,261]

Oh, crud. Well, while you are deciding how to proceed, you can do what the rest of us have to do on our pre-op diets........you know the drill. Lots of Protein, some veg, a little fruit, limited starchy carbs. Don't become part of the couch. Drink Water until your eyeballs float. So, if that door has been closed, come in through the window.

[Elode 8,093]

Appeal! That sounds like crap to me!

[ProudGrammy 8,322]

Disappointed insurance denied

@@Mz. NuNu

i have heard of OP appealing 2 and 3 times, finally getting approved

don't throw the towel in at this early stage

here is my "little" insurance story 101

i was told by my surgeons office i had been approved!!

I took what the doctors office said was the final word

i "thought" everything was fine

had uneventful surgery, easy recovery et al - GOAL

2 years AFTER surgery i received a bill for $22,000.00

yes - i said after 2 years!!!

turns out both my primary and secondary insurance denied me

i do take some responsibility

i should have asked insurance for written approval

after i couldn't get anywhere with my primary insurance about the denial

called BCBS my secondary ins

it took many months of "discussion"

finally got the approval on the phone

i was elated!!!! but.........

i requested and received a formal letter with a copy of my bill

on the bill, big word stamped

PAID IN FULL

that's my story and i'm sticking to it!!!

don't take this news sitting down

get moving

i wish you the best of luck

kathy

Edited December 10, 2014 by proudgrammy

[Toodie1974 39]

That sounds like a bunch of bs....appeal, appeal appeal!!!!

[Soontobeskinnyme 21]

I would appeal, I've read on here that there's a company who will support you in the appeal process, good luck to you, I wish you all the best.

[BLERDgirl 6,417]

So upset & hurt right now. For seven months, I have attended supervised weight loss classes, followed all guidelines from my nutrition & was looking forward to a healthier me. Only to be told that, since I have only had a BMI of 40 & above for 2 years with no co-mobs that I am not a good candidate. I am pre-hypertension & 100 plus pounds over weight.

I agree with everyone else . APPEAL Always exhaust every option to appeal. Meanwhile don't give up hope. Stay with the good eating habits you've learned.

[Mz. NuNu 19]

Thanks everyone! I put a call in to my doctor's office. Waiting on a call back. I will be appealing their decision, I have come to far to just give up, lay down or sit on the couch. LOL.>_>>_>>_>>_>>_>

My next post will be Hip Hip Hooray, surgery on the 29th as planned. I have faith!!

[Proud2BMe 1,016]

Fight it or go the self-pay route. If you decide to fight it then just know the battle can rage months to years without any progress. If you chose the self-pay option I would recommend Tijuana. Many people go to Mexico because it's far cheaper at about $4,500, including hotel.

[Cindy's WL Roadtrip 9]

Don't be discouraged. It took me two requests before I was approved. My BMI is 37 and I had mild sleep apnea. I had a lot of support from my psychiatrist, who described my ongoing weight loss challenge I experienced for years. I adhered to the 4 month nutritionist-supervised diet and was rejected the first time because I gained 2 pounds during that time. I didn't give up. I started right back up with the next 4 months of supervised diet, and I was approved!! I had my sleeve done Dec 8th. Don't let the denied claim set you back emotionally, call your insurance company and ask for their guidelines for approval.

[BusyHoosierMom 33]

So sorry to hear that. I understand how disappointing that is. I made it to pre-op on the day of surgery only to have my surgeon come in and say insurance denied that morning. I had even talked with insurance myself a couple weeks prior and was told it was covered. All they could say was sorry, that person was wrong. It's discouraging to hear, especially when you've done everything by the book to meet the criteria. Try to keep your head up. There are other options out there. You can appeal or you could explore the possibility of going to Mexico. After all the preparation, I don't want to wait any longer. I'm scheduled for surgery next month in MX.

[rich1946 8]

This happened to me too last month. I called the insurance company and told them I had not gone through six months of classes for nothing. My BMI is 40 and I have metabolic syndrome. They said my Dr. could request a "peer review" by making an appointment to talk to the medical dr. with the insurance company. That was set up for the next week and after the call I was approved! Surgery next Monday! Don't give up!

[Luvin_Life125 558]

I am so sorry your surgery was denied. Unfortunately, it happens more often than it should. Appeal the denial all the way. Your best bet when you appeal is to first get a copy of your plan's bariatric surgery coverage guidelines. Make sure you read and understand the guidelines. Also, get the exact reason for the initial denial from your insurer not the doctor's office. Once you have all of this information write your appeal using the coverage guidelines as a blueprint to show you meet a,b,c,d, etc. Keep the appeal factual and without emotion. Your best bet is to fight the denial with logic.

Good luck and please let us know how the appeals process goes.

[TriRN11 11]

I'm sorry to hear about the temporary denial. Just think of it as a hurdle. Definitely appeal again! Don't give up. I can't imagine how frustrating it must be to go through all of the appointments and nutrition counseling, and of course the hopes and dreams of what this will bring to your life. Please don't let this get you down. Do you have sleep apnea? Maybe getting a sleep study/ sleep apnea diagnosis would help your case. I hope everything works out for you.