Denied/Appealing Questions About Pre-Op Requirements

[BabettesFeast 17]

Hi all - I'm really stressed. My insurance denied my DS surgery. My surgeon is appealing. She's very experienced with this an is tenacious. Surgeon wants me to keep attending pre-op classes/appointments and stay on the schedule for surgery June 14! (Insurance person at her practice says they will likely have an answer w/in 15 days).

While I hope I win the appeal, I have to ask: if I'm denied again will I be on the hook for the many doctor's visits, nutritionist, psychologist, pre-op testing, etc. that have led up to this?! Why don't docs confirm the insurance *first* before getting patients in the pipeline and giving what may be false hopes?

Thanks in advance for your responses!

[GreenTealael 24,852]

Do what the doctor states. Insurance may find many reasons for denial thay may not have anything to do with coverage, it could be a single paper not signed, something missing during the submission process, etc. Keep going and don't give up! 💙

[Briswife15 889]

Yes, keep going. Hopefully it will all work out, but it was your responsibility, not the doctor's, to confirm coverage. GreenTealael is right, there are lots of reasons for a denial.

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[apiane 174]

A year ago I had a surgery date, was ready to go, and insurance denied. Then I was 38 BMI so I needed a co-morbidity. I have sleep apnea. But when they submitted to insurance, they were told my SA was not "bad enough". You had to have 20 interruptions a night, and I had 15. My surgeon even appealed and did a call with United Healthcare herself. I was so devastated. A year later I was at 41.3 BMI and didn't need a co-mobidity. I've been going through the pre-op requirements, and I've lost weight and am down to 39.8 BMI. I was really concerned that I won't be approved, but then was just diagnosed with Type 2 Diabetes (now I have a solid Co-Morbidity) so I'm feeling hopeful. I guess I'm telling you my story to say "Chin up". It will happen for you. But it is a good idea to call your insurance company.

[NYJenn 1,461]

I can’t stress enough how important it is to understand your coverage. It will involve calling your insurance company and asking LOTS of questions. I was on the phone 30-40 each time but I knew exactly what I was responsible for, what was covered, if I would be approved, etc. it’s a pain, but totally worth it