Beyond Sad Request Deneied

[DivaSoBlessed 97]

Hey just reading your post and I think you said on one of the letters it said blue distinction center well that's apart of my policy as well not all centers are there are usually a select few in your state that are I actually had to switch programs because of that. Google blue distinction centers in your state and if your hospital isn't listed then you need too go to one that is

Thank you so much Jessica. The place where I am trying to have the surgery approved is actually a Blue Distinction Center. It is the reason that I chose it and is the only one closest to where I live. Hopefully I can have all of this straightened out with these letters next week. Thanks again for the tip. ????

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[Alex Brecher 10,516]

@@DivaSoBlessed,

I am so sorry to hear that. That sounds like an unacceptable response. If you’ve met every requirement, how could your insurance possibly deny you if you’re entitled to it? I agree with @@cbrown1 – it was easier to deny than to chase down your info, and they should review your COMPLETE file! Call your insurance provider (or your HR person if you’re getting insurance through work).

If you can’t get through or if they’re not helpful (a lot of the time, they’re not!), call your surgeon’s office. It’s in their interest for you to get surgery. They probably deal with this all the time and know how to help you. If not, find another surgeon. Some bariatric surgeon will help.

I am sorry, but keep your chin up and keep moving forward.

[DivaSoBlessed 97]

@@DivaSoBlessed,

I am so sorry to hear that. That sounds like an unacceptable response. If you’ve met every requirement, how could your insurance possibly deny you if you’re entitled to it? I agree with @@cbrown1 – it was easier to deny than to chase down your info, and they should review your COMPLETE file! Call your insurance provider (or your HR person if you’re getting insurance through work).

If you can’t get through or if they’re not helpful (a lot of the time, they’re not!), call your surgeon’s office. It’s in their interest for you to get surgery. They probably deal with this all the time and know how to help you. If not, find another surgeon. Some bariatric surgeon will help.

I am sorry, but keep your chin up and keep moving forward.

Thank you so very much for your words of encouragement Alex. I just got off the phone with my Surgeon's Office and was ready to give a long drawn out speech about thes letters that I received only to find out that I GOT APPROVED!!!!! My head is spinning right now. I got histerical for nothing. The coordinator said that it was for one code they usually send of for approval and they always get a denial for it. Crises averted, now I can breathe and prepare for the next leg of this journey. Than you all so very much for your love and support. I can't think of a better place that I'd rather be than here with you all.

[Brittneysue12345 18]

@

• DivaSoBlessed

Im just goign to my first appt today ! prayers for you.. i wanted to see if you had an update? did you call today?

you did get approved !!!

woohoo !!!!!

[DivaSoBlessed 97]

@@Brittneysue12345 Good morning! Yes I just found this morning that I GOT APPROVED!!!! I am feeling so many emotions right now I don't know whether to laugh or cry. Thank you so much for your prayer's. I will be praying for you as well. Please keep me posted on your progress.

[Brittneysue12345 18]

I'm just ready to rock this journey!

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[muhol88 16]

@@DivaSoBlessed so happy to see the last post from you!! I know how frustrating this whole journey is. I was just told by my surgeons office that my insurance changed from last year and now require 6 month work ups with my primary Doctor! I was on path to June surgery, now looking at September! Best of luck with your journey! Looking forward to hearing all your updates!

[Dawnie Doo 184]

This coming October will be 3 years since I started this process. Since I started they lost my paperwork 3 times and bumped my surgery date because they booked me on Easter monday by accident trust me when I say I know exactly how you feel. Throughout this process I have said I'm quiting more then my fair share and I realized your that much closer from when u started there's nothing going to hold you back if you are persistent. I did more then jump through hoops for these people and it was what seemed like one thing after another. it pays off don't give up!

Your post actually helped me too lol Good advice!

Dawnie_doo

[DivaSoBlessed 97]

@@Brittneysue12345 You've got this in the bag! I can't wait for us to make it to the losers bench. I just scheduled my surgery for the first week of July. Stay steady on the path and let's rock this out!

Edited March 14, 2016 by DivaSoBlessed

[DivaSoBlessed 97]

@@muhol88 You are definitely right it can be very frustrating but I'd go through it all again just hear that I have been approved. Stay the path and hang in there so that we all can make it to the losers bench together. I wanted to have surgery by my birthday next month but I have out of pocket expense that I have to pay before I can have the surgery done so I pushed it back to the first week in July.

Edited March 14, 2016 by DivaSoBlessed

[Dr-Patient 831]

Call your doctor's office. Make sure you have a copy of your records. Go over EVERYTHING in the record. Was the info sent up via 'electronic medical records'[EMRs]? Did the doctor document everything, and correctly?

EMRs are NOT always accurate; many times, they are not [the default is often "nl" and unless the doc is diligent about accurately documenting everything, your true story/Dx/and findings are lost.

Appeal, appeal appeal. Your surgeon should be able to write a strong letter, with appropriate medical verbiage, on your behalf. And I mean a LETTER, not just some checked off boxes.

We are in BAD times these days with health care delivery and insurance companies running every darn thing. Patients have to FIGHT.

Don't give up. Good luck.

[DivaSoBlessed 97]

Thank you so very much for your encouraging words!!! They mean the world to me. I actually spoke with my surgeon's office this morning and found out that I am approved. I will be having surgery the first week of July.

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[Valentina 2,642]

Told ya so................................

So, there-----------------------------------------------------

Dusting off your spot on the "Losers' Bench"...

Waiting for you.

Keep posting so we all can keep our eye on you. You need it!! (we all do).

[DivaSoBlessed 97]

@@Valentina Thank you! I can't wait!!! Mine transformation doesn't start until July but I am happy that at least it will be summer and no winter coat will be needed when it happens. I will definitely keep posting.

[farooforever 20]

I have to tell you... insurance companies play so many games to Not pay for the surgery. My surgery was denied twice. I had to be on them... every single day for over 2 months. After it was denied the second time and they had everything that was required to be eligible I asked them how do I appeal it. Your surgeon needs to do a peer to peer review with them. The medical director that oversees your insurance company speaks directly with the surgeon over the phone. They go document by document through your file and your surgeon will discuss why it is all justified.

The denial letters I got were signed by that medical director but I can tell you he has a team of people with an auto print for denied. They will make up that they didn't get this that or the other. I finally got mine approved after almost giving up as well. It sucks that they do this. I think they try to weed out people who aren't determined to fight them. If they haven't already done it, do a peer to peer review. If they still deny it and you meet all of their requirements, it's time to call an attorney.