Don’t have a good feeling....

[KimB7811 115]

So I get a phone call this morning from my Surgeon himself asking a question on my history. Apparently my insurance company contacted them today asking for more information on a subject. I never smoked a cigarette in my life, but occasionally in the summer will smoke a cigar here and there with my husband. Somehow it got put in my medical history that I’m a smoker!? So he asked about this again because my insurance specifically says patient can not smoke in the past 6 months or it’s an automatic denial. Well I said the last time I had a cigar was last July and I never had a cigarette in my life. So he said he will adend that in my history and submit it so that problem was cleared. Then he said the second thing they are requesting is all my weights from the weight loss program I did for the last 2 years to see my BMI’s. I started in 2016 with a BMI of 42 but then dropped to a BMI of 34 briefly up until November of 2018 before I have steadily gained back up to BMI of 37 now. Only thing is insurance might likely deny me because I haven’t been over BMI of 35 for a full year. Which was a requirement for Fed BCBS. Praying they take into consideration my overall weight loss attempt the past 2 years. My surgery is scheduled for next Thursday and I’m freaking out! I just don’t have a good feeling now at all about getting approved.

[gabybab 696]

Omg they will find any excuse to try and not cover surgery. I hope you get an answer soon! Good luck!

[Diana_in_Philly 1,426]

Don't panic. Sometimes things just get charted wrong. For some reason, at one point, my allergists office had that I was allergic to peanuts. Never have been. So, don't panic. Your doc will write the letter. If they deny, he can request a peer-to-peer review which would require the carrier to provide a teleconference for him with a bariatric surgeon of their choice to review the file and make a determinations. Peer-to-peer usually overturn the initial denial.

[MARKINKUWAIT 7]

yeah, my insurance tried to say that sleeve surgery was "elective plastic surgery" even though i suffer from DVT, high blood, apnea, etc...finally after a psychological eval, they approved 95%...

hang in there

[BulletWithButterflyWings 422]

15 hours ago, KimB7811 said:

So I get a phone call this morning from my Surgeon himself asking a question on my history. Apparently my insurance company contacted them today asking for more information on a subject. I never smoked a cigarette in my life, but occasionally in the summer will smoke a cigar here and there with my husband. Somehow it got put in my medical history that I’m a smoker!? So he asked about this again because my insurance specifically says patient can not smoke in the past 6 months or it’s an automatic denial. Well I said the last time I had a cigar was last July and I never had a cigarette in my life. So he said he will adend that in my history and submit it so that problem was cleared. Then he said the second thing they are requesting is all my weights from the weight loss program I did for the last 2 years to see my BMI’s. I started in 2016 with a BMI of 42 but then dropped to a BMI of 34 briefly up until November of 2018 before I have steadily gained back up to BMI of 37 now. Only thing is insurance might likely deny me because I haven’t been over BMI of 35 for a full year. Which was a requirement for Fed BCBS. Praying they take into consideration my overall weight loss attempt the past 2 years. My surgery is scheduled for next Thursday and I’m freaking out! I just don’t have a good feeling now at all about getting approved.

Be sure to keep us posted love. HUGS.

[KimB7811 115]

On 4/18/2019 at 5:21 PM, Diana_in_Philly said:

Don't panic. Sometimes things just get charted wrong. For some reason, at one point, my allergists office had that I was allergic to peanuts. Never have been. So, don't panic. Your doc will write the letter. If they deny, he can request a peer-to-peer review which would require the carrier to provide a teleconference for him with a bariatric surgeon of their choice to review the file and make a determinations. Peer-to-peer usually overturn the initial denial.

Thanks Diana. It’s encouraging knowing that my Dr might be able to change their minds if they deny me.

[KimB7811 115]

On 4/18/2019 at 9:23 PM, MARKINKUWAIT said:

yeah, my insurance tried to say that sleeve surgery was "elective plastic surgery" even though i suffer from DVT, high blood, apnea, etc...finally after a psychological eval, they approved 95%...

hang in there

That’s ridiculous! It’s insane how they will view this surgery that saves and extends lives! It’s not a boob job! Lol

[KimB7811 115]

On 4/19/2019 at 8:51 AM, BulletWithButterflyWings said:

Be sure to keep us posted love. HUGS.

Still waiting.... Day 4 of liquid diet right now. If I get denied I might stick with this diet a little longer though. Lost 6 pounds already in 3 full days lol.

[KimB7811 115]

On 4/18/2019 at 5:19 PM, gabybab said:

Omg they will find any excuse to try and not cover surgery. I hope you get an answer soon! Good luck!

Yes they will and that’s what I was afraid of! Ugh