Wondering who out there had success in getting their initial denial overturned? Would love to hear your story!

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Edited August 30, 201610 yr by casenior

I wasn't denied but I work in insurance. You need to focus on why they denied you and ensure you provide the information that shows you meet all the requirements.....You should have gotten a letter that states the specific reason/s. So whatever the reason they denied you work on getting together the documentation that shows they shouldn't have. Good luck!

@@kmorri I have 2 eligibility requirements. 5 years 40+ bmi and over the age of 21. They denied me for not having 5 years 40 bmi but this is a revision surgery for an eroded lapband I had removed in 2011.. I didn't get back up to 40 bmi until 2014 (lost 60 lbs with the band and it was covered under this same policy)

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@@casenior Ok that may be tough to get approved. Perhaps using all the documentation you had for getting the lap band approved will help. In addition, you may want to check to see if your surgeon can do a "peer to peer" review. That's where your surgeon can argue your case with a physician/medical director on staff with the insurance company. Lots of times those go well, but your physician would have to request it.

I hope it works out for you. Keep me informed on how it goes. Good luck!!

@@kmorri they already did the peer to peer and the guy was just a regular primary care physician and said he wasn't able to overturn the weight history denial but suggested we submit everything to appeals along with a letter explaining why.. This time I have other comorbidies as well so who knows. Hopefully an actual surgeon can review it.

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@@casenior Good for you. I'll keep my fingers crossed for you. Is your BMI over 35 with the new comorbidies?

It's been over 40 for 3 years including this year but insurance doesn't include the current year

@@kmorri

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Edited August 31, 201610 yr by casenior