Insurance denied

[ChristineZ 41]

I have the lapband. My band is no good so I’m going to get the sleeve. My doctors office calls my insurance and my insurance tells them all the requirements to have the revision to the sleeve. I go through 6 months of insurance requirements and now we submitted it to insurance and they are saying it’s not covered through my insurance plan. My doctors office has the codes and requirements they said I needed and now in my plan it says it’s not covered! I’m furious! Why did they give the codes and requirements and also cover the 6 months of requirements if it’s not covered! We are appealing it. Then if that doesn’t work I’m going to talk to a lawyer about what to do if they deny it again. Anyone have any advice? I just can’t believe they would say it’s covered and make me jump through hoops then say it’s not part of my plan! Ugh!

[Sosewsue61 3,185]

Bummer!! Good luck.

[GassyGurl 428]

Lindstrom obesity advocacy is a law firm that works with clients who have been denied. I haven't used them, but have read great things.

Sent from my XT1254 using BariatricPal mobile app

[TheNewMrsR 249]

I have the lapband. My band is no good so I’m going to get the sleeve. My doctors office calls my insurance and my insurance tells them all the requirements to have the revision to the sleeve. I go through 6 months of insurance requirements and now we submitted it to insurance and they are saying it’s not covered through my insurance plan. My doctors office has the codes and requirements they said I needed and now in my plan it says it’s not covered! I’m furious! Why did they give the codes and requirements and also cover the 6 months of requirements if it’s not covered! We are appealing it. Then if that doesn’t work I’m going to talk to a lawyer about what to do if they deny it again. Anyone have any advice? I just can’t believe they would say it’s covered and make me jump through hoops then say it’s not part of my plan! Ugh!

That happened to me twice in the last 4 years. Months of my time wasted and major expenses for my co pays, plus all the time I missed from work for all the appointments.

Each time it happened, I switched insurance during open enrollment at work and started all over again with a brand new doctor. Third time was a charm. Found a doctor who knew how to advocate for me and got everything approved and my surgery will be Nov 1, 2017.

Sent from my XT1635-01 using BariatricPal mobile app

[ProudGrammy 8,322]

On 10/11/2017 at 0:49 PM, ChristineZ said:

not covered through my insurance plan.

what a mess!! you went through all requirements

then they turn around and say NO!!

IMO - best thing to do is appeal, appeal and appeal!! know from

the board that some OP have fought hard for a win.

some OP have appealed up to 3 times!! finally won!!

please do not give up. (that's what insurance wants you to do

put your fighting gloves on and knock them out til they hurt!!

you pay for insurance - and then they say NO!!!!

they just don't want to pay YOU, after you pay them.

MONEY, MONEY, MONEY makes the world go around!!

don't give up!!

good luck - kathy

[Klynngetsfit 42]

On 10/11/2017 at 0:49 PM, ChristineZ said:

I have the lapband. My band is no good so I’m going to get the sleeve. My doctors office calls my insurance and my insurance tells them all the requirements to have the revision to the sleeve. I go through 6 months of insurance requirements and now we submitted it to insurance and they are saying it’s not covered through my insurance plan. My doctors office has the codes and requirements they said I needed and now in my plan it says it’s not covered! I’m furious! Why did they give the codes and requirements and also cover the 6 months of requirements if it’s not covered! We are appealing it. Then if that doesn’t work I’m going to talk to a lawyer about what to do if they deny it again. Anyone have any advice? I just can’t believe they would say it’s covered and make me jump through hoops then say it’s not part of my plan! Ugh!

I am an appeals specialist for an insurance company. The best thing that you can do or ask your Dr to do is 1st and 2nd level appeal, also ask for a peer to peer review (Dr will know what that is). See if you can get a copy of the policy and read with a fine tooth comb the exclusion and the reason for denial. If all else fails you can go to the Dept of Ins for the state you live in.......Also I am more than happy to help you out if you have questions or need help understanding the insurance lingo, its kind of what I do.

Best of luck!!!!