I just came from the mailbox retrieving 4 letters from my insurance provider. After getting all of my clearances completed some how I still got denied. I am sitting here in tears, and frustrated as well as exhausted with this entire process.

The letter says reason(s):

Inadequate or no clinical data received to complete review. I have no more words and am feeling like maybe this is just my life and I should except it. Going to bury my head under a pillow now. #sotiredoffighting

@@Valentina Thank you so much. That's a great idea! I have an appointment coming up with them so I am not leaving until we all sit down and figure this out. I have come too far for this to go all down hill now. I will keep you all posted on what happens.

Whew!!! That was a close one!

That's my girl!

Really, whenever you're questioning your journey or have hit another wall, come here and post. You probably can't come up with a problem that someone on this site has not had to tackle at some crossroads on their WLS journey.

If you do come up with a situation that none of us have had to solve, just think of the conversation thread that would make!!!! Wow! It will go on for miles and miles. --but in the end I'll bet we will come up with a solution.

We are all on the journey together. Sure we each have to walk the walk alone, but right next to us is a friend keeping pace along side.---only a hand hold away.

The first letter meant they didn't get all the documentation they require from your doctor. I believe the last letter is the authorization and this mess is about paperwork catching up to paperwork. Which insurance company is this?

It's Blue Cross Blue Shield PPO+ So if I am reading you right this is not really a denial but that they just don't have all of the info needed from my surgeon? I don't understand why so many people are having paperwork issues when it comes to insurance. This is just annoying.

Edited March 12, 201610 yr by DivaSoBlessed

@@Valentina Thank you so much. That's a great idea! I have an appointment coming up with them so I am not leaving until we all sit down and figure this out. I have come too far for this to go all down hill now. I will keep you all posted on what happens.

Whew!!! That was a close one!

That's my girl!

Really, whenever you're questioning your journey or have hit another wall, come here and post. You probably can't come up with a problem that someone on this site has not had to tackle at some crossroads on their WLS journey.

If you do come up with a situation that none of us have had to solve, just think of the conversation thread that would make!!!! Wow! It will go on for miles and miles. --but in the end I'll bet we will come up with a solution.

We are all on the journey together. Sure we each have to walk the walk alone, but right next to us is a friend keeping pace along side.---only a hand hold away.

Lol Valentina that is exactly why I posted here trying to understand what was happening knowing that someone else might have experienced this same issue. I am happy to be on this journey with all of you because outside of my husband know one else really understands so I don't bother bringing it up. I am so grateful for the support that I can get here from friends. I will let you know how it goes for sure.

Hey lady just saw your post...don't give up...quitting is not the answer. Find out and I think it's an admin error on insurance or Dr's office! Good luck!

Sent from my SM-G900V using the BariatricPal App

One thing you will find out is that bariatric surgery not only changes you physically, it changes you mentally. Because of situations like the one you are facing, or getting flack from family, or struggling with your diet.......it all makes you stronger. You come out of this tougher that you ever thought you would be.

Going through the pre-op hoops is far more aggravating than your post-op recovery. This is the hard part - not the surgery.

"Whatever you can do, or dream you can - begin it! For boldness has genius, power, and magic in it." Wolfgang von Goethe"

Hi I work for a large health insurance company. What your letter is saying is that they did not have all your information at the time of your review to approve it. This happens alot clinicals didn't make it in time because they were sent separately , one sheet was cut off when it was faxed, or the whole packed arrived after the review. We do not go back looking for that missing information we notify you so your provider can follow up and find out what we need. So the fastest route is to take it to the billing dept at your dr office. The billers work closely with us. Let them see your denial it should be resubmitted for additional review. If you were denied it would say not medically necessary or not covered benefit etc.....

Best of luck I'm praying for you;)

I was denied two times ask your doctor to do a pier review on your behalf to the insurance company.

@ Thank you so much. I won't give up because you are right quitting is definitely not the answer. There definitely has to be a mix up with the paperwork is what I am thinking because the surgeon assured me that I didn't need anything from my PCP and that I just needed to get clearance through a pulmonologist, cardiologist, and psychologist which I did and submitted all forms. I walked two of them into the office myself. I am not sure what happened after that but I hope that everything is figured out soon. I'll be on it first thing Monday morning.

@@Miss Mac Thank you! I can definitely see how people can become very frustrated with this process because you definitely jump through hoops to get to where you need to be. I am going to remain strong and not give up so easily out of frustration. I am stronger than that. I just had to vent because it has been a long day and that was the icing on the cake. I'm more level headed now that I have had a chance to calm down. If this is the hard part then I can't wait to get to the easy part of post-op and continue with my fight. I am doing so well right now and I don't want to sabotage my work thus far. I'm gonna pull up my boot straps and get busy first thing Monday. Thanks again for your kind words my friend. I appreciate every response made here.

@@cbrown1 Thank you so much for your insight. That makes so much sense. I can see how the insurance companies would not have the time to go back and look for missing pieces of paperwork. It would take them far too much time just to look for every missing document. I will definitely contact them first thing Monday and ask to speak with billing to find out what was not sent or what is now needed for them to complete their review and give their final decision. Your input has definitely helped me to understand what these letters are saying because it was so confusing as I was reading each one. Now I can breathe a little better. Again I really appreciate your help on deciphering this information. I feel much better now.

Hang in there Diva. Your still in the game, sounds like they only need more info to review your case. Call your Dr's office and the insurance carrier Monday morning. Don't give up. [emoji4]

@@Indygirl1 So sorry to hear that you had to go through this as well. I will be giving them a call first thing Monday morning. I have an appointment coming up with them so I can also bring the letter in with me to get everything figured out so that they can do another review with all of the necessary paperwork needed to reach their decision. Thank you so much for your input. It is truly appreciated.

DivaSoBlessed

When you call the insurance make sure you document what day and time you called and the reps name you spoke with. If they don't volunteer their name, ask for it.

Yes, it sounds like they just need more information. Don't freak out.

I'm thinking I got a similar letter as your last letter. I have BCBS of TX. It was confusing because they said I had met all of the requirements, but yet predeterminination didn't guarantee payment. Very confusing. They ended up paying for mine, but it did have to be at one of their designated centers for excellence. Luckily my surgeon agreed to go to that hospital. It was not a very good hospital unfortunately, but they negotiated a very cheap rate so I'm sure that is why they do it.