Jump to content
×
Are you looking for the BariatricPal Store? Go now!
$99 Yearly Supply Alert! 🌈 "1 per Day!" Bariatric Multivitamins

Denial?! [emoji54][emoji24]

Mysticpink74

By Mysticpink74, in Gastric Bypass Surgery Forums

Recommended Posts

Mysticpink74    50

Mysticpink74
Posted

I Can't believe it...I have sleep Apnea, Acid Reflux, I weigh 310 (327 starting weight at 5'0" so over 44BMI), chronic back/knee pain that I go to pain management for and take Vicodin, Clinical Depression, & I got DENIED from surgery on 8/24! I put an appeal in (over the phone w/ a UHC operator) on 9/1...so hoping it gets turned around... I still have not got the denial letter so I don't know why I got denied! UHC told me my provider would let me know or Last I spoke they hadn't received a reason but told me I'd get a letter...but I haven't gotten a letter yet...

I don't understand how I got denied?! I thought I had plenty to be a shoe in?! I'm so frustrated I was so looking forward to getting in August surgery date... I don't know how long the appeal will take but now I have to wait that much longer...

Any one have tips to turn this around or know how long it takes for an appeal to be turned around? Or if there is a chance that I'll get DENIED again or think I'll get accepted w/ all my co-morbidities....I mean is it just a routine thing that they deny you at first, to see if you'd never try to make an appeal?

Lmk....TY

Sent from m

Share this post

Link to post
Share on other sites

dhrguru    1,238

dhrguru
Posted

From what I read here, you technically only have one co-morbidity-- apnea. The "usual suspects" for co morbidities include high blood pressure, diabetes, or high cholesterol and apnea. Depression and joint pain aren't co-morbidities, since neither in their own can kill you (debatable I know)

What was your insurance requirements? I think I would review the file with your surgeons office before the appeal to see if everything was submitted. Sometimes it's just a case of something not being received. Definitely File every appeal you can.

Share this post

Link to post
Share on other sites

James Marusek    5,244

James Marusek
Posted

Ty! Will do... & not sure how to look up requirements for my insurance I'll call & ask....

Sent from m

Many have their policies on-line. Do a search on the health insurance company. Then when you find the company, see if they have the current policy plan available on-line. Go thru it and find the area that deals with bariatric surgery.

Share this post

Link to post
Share on other sites

JayVSG    21

JayVSG
Posted

Call your insurance and ask, my insurance company didn't offer gastric sleeve (bariactric surgery) even though I am obese it just wasn't part of my plan, I ended up going on my wife's insurance and they covered it

Sent from my SM-G920V using the BariatricPal App

Share this post

Link to post
Share on other sites

cuteNATL    93

cuteNATL
Posted

Sounds like each insurance company is different. With mine, you just need a high BMI or 1 comorbidity and they approve you. Hope it works out for you sweetheart!

Share this post

Link to post
Share on other sites

rebelchelz    52

rebelchelz
Posted

Mine was approved but I changed surgeons because new surgeon was in network but it was denied because hospital wasn't a blue distinction center. Now found new surgeon in network & at proper facility. Insurance can be very finiky.

Sent from my VS990 using the BariatricPal App

Share this post

Link to post
Share on other sites

Mysticpink74    50

Mysticpink74
Posted

@@Mysticpink74 You need to find out why you were denied first. It may have been incorrectly submitted or missing info. You have a high BMI (over 50) and usually don't need a comorbidity. There has to be another reason. Did you meet all of their preop requirements?

Sent from my KFFOWI using the BariatricPal App

Yes I met all requirements & even got a letter from my surgeon saying "Congrats you've met all requirements needed for you UHC insurance" then it went on to say it would take a few days for the nurse to write up something & submit it to my insurance ...I waited a week & called and.....well...you know the rest

Sent from m

Share this post

Link to post
Share on other sites

Shi-Shi80    73

Shi-Shi80
Posted

I have UHC as well and I'm wondering if it's the surgeon that's the issue. Is your surgeon's practice considered a "Bariactric Center of Excellence" because that was necessary for my insurance? I know each company has its own criteria but my UHC provider required my surgeon to be part of this and I had no issue with getting approved. Check and see if that's the issue.

Share this post

Link to post
Share on other sites

Mysticpink74    50

Mysticpink74
Posted

I have UHC as well and I'm wondering if it's the surgeon that's the issue. Is your surgeon's practice considered a "Bariactric Center of Excellence" because that was necessary for my insurance? I know each company has its own criteria but my UHC provider required my surgeon to be part of this and I had no issue with getting approved. Check and see if that's the issue.

Will do!

Sent from m

Share this post

Link to post
Share on other sites

Mysticpink74    50

Mysticpink74
Posted

I also have UHC and I have all the things you mention I was approved in two days being sleeved Tuesday

Sent from my iPad using the BariatricPal App

lucky girl ...hope this appeal goes fast! Cuz me & my fiancé jst set our wedding date for 4/1/17 (his bday) & obviously I want to lose as much as I can by then!! ????

Sent from m

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
Go To Topic Listing Gastric Bypass Surgery Forums

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • BeanitoDiego

      BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
      · 0 replies
      1. This update has no replies.
    • ChunkCat

      ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
      · 0 replies
      1. This update has no replies.
    • Onedayatatime365

      Onedayatatime365

      Looking to connect with others who are also on the journey of better health. Post-Op Gastric Sleeve (4/11/24).
      · 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

    Bariatric Forums

    For Patients

    Health Professionals

    Search Surgeons

    Bariatric Surgeons: Want to research a weight loss surgery surgeon? Enter their last name below to start!

    ×