Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Recommended Posts

I was all geared up to get my surgery late January, early Febuary... and now - my insurance rejected the submission because they say its not medically necessary. I have the EDG and swallow test scheduled for early January, it wasn't required by my insurance - so we put it off til after the first when I'll have access to my flex spending account. And now... I'm hoping they find something seriously wrong with me or I won't be able to get my sleeve done. If they find everything to be normal - insurance won't pay for the surgery. :(

I feel like I got my hopes up and was ready to go with this... only to find out I might not be able to get it now.

Share this post


Link to post
Share on other sites

Your weight looks like you should be good for the BMI, don't you have any co-morbidities?

Share this post


Link to post
Share on other sites

is self pay an option.

$4,000 for surgery is very very much money well spent for me.

I would spend more than that on fad diets and health food store products

Share this post


Link to post
Share on other sites

No, I don't have any co-mobidities - I'm fairly healthy except that I'm overweight... I've been lucky so far with that. But my father died at 52 from a massive heart attack - he had diabetes and he was over 350lbs, and I don't want to go that way.

I have minor issues with my knee, part weight related and part an old injury that I had surgery on 16 years ago.

If I had any money saved up or able to get a loan - I would totally go self pay, but I am not in a financial position to be able to do that. :(

Share this post


Link to post
Share on other sites

I feel like many people get their decision overturned by appeal. It seems like some insurance companies reject everyone as a first step and then when people fight the decision will get their approval. I've seen lots of people say that just in these forums. Maybe don't give up?

Share this post


Link to post
Share on other sites

As @ said,appeal the decision. Best of luck!

Share this post


Link to post
Share on other sites

My insurance requires that I go through a three month medically managed Weight loss program before surgery could be considered . I fulfilled my obligation and my insurance company still denied me. My surgeon ( Dr Snyder, Denver Colorado.... Who is amazing by the way) said it didn't surprise him and that he would take care of it. So he called them and the next thing I know , I had a surgery date, and here I am 3 weeks post op.

Did you insurance co tell you why they didn't think it was medically necessary?

Share this post


Link to post
Share on other sites

You can appeal this. Talk to your doctor about resubmitting the request. Also call your insurance and ask to be assigned a "health care advocate". The advocate is there to help you. Also, if your insurance is thru your employer find out if they have someone that can help. Do not give up. It is your life and your body. Fight for your health!! Get the book "Weight Loss Surgery for Dummies". It has tips on dealing with insurance. Barnes and Noble or Amazon for about $20.00.

Share this post


Link to post
Share on other sites

I talked to my Surgeon's assistant - she suggested that we wait until after the EDG and swallow study which is in January. Once that is done - I'll have more backup for getting it appealed. They stated it wasn't medically necessary because I hadn't proven slipage or erosion - and that they want recent as in the month that its submitted proof. Least thats what the SA says - I'm not giving up I'm just fustrated because I worked really hard trying to get my old medical records - even went to the hospital to get copies because True Results (where I got my lapband done) didn't even have record of me being there anymore... because it was in 2007/2008...

I'm gonna do the EDG and swallow study - see what happens when we resubmit and go from there.

Share this post


Link to post
Share on other sites

Good luck! I am rooting for you!

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

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Hesitant but hopeful

      Hey October Surgery friends...how are you doing? I've lost 15 lbs since surgery on 18th.42 lbs overall. Wearing clothes that feel great. Had a bout of cold and stomach flu and still having some nausea off and on after that but getting better, I think. 
      Seems like I fill up and have minor pain quicker when I eat hot foods rather than cold. Anyone else notice this?
      Still sooo glad I did this.
      · 2 replies
      1. Bettyboop56

        I had surgery Oct 29. Lost 35#. Plateau now. But seeing what clothes fit now is encouraging.

      2. Bettyboop56

        My surgery was 10/19. #40 down since surgeon pre op visit. Getting close to end of soft foods. I think only issue going to regular foods is portion size. So far trying a new food every day. With no issues.

    • Merri Beth  »  SamaLotus

      Hi I just saw that you are in Las Vegas too. We are going to the same center. Dr Laduc in same office as Dr Atkinson, is doing my sleeve on Nov. 28th.  I wish you the best!
      · 0 replies
      1. This update has no replies.
    • Jessica100858

      24 days and counting down til surgery 
      · 0 replies
      1. This update has no replies.
    • Bunny78

      Just over 2 weeks post-op….I’m getting there
      · 0 replies
      1. This update has no replies.
    • Voogs  »  KimA-GA

      always look forward to your updates, Hope you are well.
      · 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

    ×