Denied due to no disabling condition

[Brenda Sherwood 64]

I'm so frustrated. I have done so much to get approved for this surgery and was just told I was denied due to not having a disabling condition that requires this surgery. I meet all their conditions stated in the handbook that says bmi over 40 doesn't require another condition. My bmi is 46, wven after losing 25lbs on my dr supervised diet. We are sending in an appeal. Anyone else go through this?

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[bellabeans 74]

What ins do you have ? It's so frustrating what we have to go through

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[KristenLe 5,979]

I think some insurances just deny and hope no one fights it! Tell them you want the policy in writing and file an appeal. Ask your surgeon's office for help.

[2goldengirl 2,076]

Firstly, I've never seen the midical policy that spitulates "disabling condition", the more common term is "comorbidity", which isn't at all the same thing.

Do you have a copy of your health plan's policy concerning WLS? If you don't call and ask for it. That way you know what the requirements are up front.

Good luck with your appeal!

[Brenda Sherwood 64]

I have the policy and meet all their requirements. This is something new the are pulling out.

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[KristenLe 5,979]

Tell them whatever this rule is that you need it in writing. Go to the Obesity Action Coalition website - they have some good info on appealing. Talk to your surgeon's office too - they should help.

[jane13 2,256]

appeal. dot all the "i"s and cross the "t"s.

insurance companies will deny for obscure things.

keep us posted.

[audaciousmarie 161]

I'm so frustrated. I have done so much to get approved for this surgery and was just told I was denied due to not having a disabling condition that requires this surgery. I meet all their conditions stated in the handbook that says bmi over 40 doesn't require another condition. My bmi is 46, wven after losing 25lbs on my dr supervised diet. We are sending in an appeal. Anyone else go through this?

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That is so strange. Usually you are automatically eligible with a bmi over 40.

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[Brenda Sherwood 64]

Its Amerigroup, which is through medicaid. They used to require a 3 year pre op diet so no one ever did it. They just changed the requirements a few months ago so Im in the first batch of people going through and trying for approval. Apparently according to my doctor they are denying everyone for some reason or another. Trying to appeal but not going well

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[Inner Surfer Girl 12,015]

Document everything.

[2goldengirl 2,076]

Find out what the NV Medicaid policy is concerning bariatric surgery. Amerigroup will have a contract with the state that can't deny you unless you don't meet the State's requirements.

[Brenda Sherwood 64]

My Surgeons office thinks I will eventually get approved because I meet the requirements, just thinks they are trying to draw it out in hopes that we will give up. Im calling again in the morning to get the latest. Not giving up...still on my liquid diet in hopes they approve. Ill be ready to go. Worst case scenario, I detox my body and shed some pounds. Its not as hard as I thought it would be

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Edited May 3, 2016 by Brenda Sherwood

[audaciousmarie 161]

Its Amerigroup, which is through medicaid. They used to require a 3 year pre op diet so no one ever did it. They just changed the requirements a few months ago so Im in the first batch of people going through and trying for approval. Apparently according to my doctor they are denying everyone for some reason or another. Trying to appeal but not going well

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3 year pre op diet? That is preposterous...geez talk about a deterrent.

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[KristenLe 5,979]

Contact the State Medicaid office and notify them of the difficulty you're having. Amerigroup is clearly trying to avoid paying for services they get paid to cover. I would notify Amerigroup that you'll be speaking directly to Medicaid about this issue.

[Read2016 658]

Obesity is a disease, it needs treatment not delays to treatment... There is no other disease we could have that's met with denial of treatment nor being forced to prove what you have done to treat it... Obesity is the only thing our political correct society has not embraced, it's still socially acceptable to have bias against obesity.

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