Insurance

[KariLinn 0]

I am having trouble getting approved from Molina healthcare. My doctor has sent approval saying I need the surgery and they keep not approving it. Can somebody please help me. Thank you 😪

[catwoman7 10,845]

is bariatric surgery covered in your particular policy? Policies can vary among employers, even if they use the same insurance companies. Some employers choose not to include a bariatric surgery rider, even if the insurance company offers one.

if your employer's policy DOES cover bariatric surgery, do you meet all the requirements?

[KariLinn 0]

Yes but it is state insurance and the place that I am trying to get surgery does take my insurance.

[catwoman7 10,845]

15 minutes ago, KariLinn said:

Yes but it is state insurance and the place that I am trying to get surgery does take my insurance.

here are the requirements. Do you meet all of these? If so, did they give you or your PCP a reason for denying you?

https://www.molinacenter.com/-/media/Molina/PublicWebsite/PDF/Providers/wa/Medicaid/1023-2009_23924_CM-Provider-Bariatric-Program-Flyer-Update_nob_FNL_508c.pdf

[KariLinn 0]

Thank you. I have read through that and I have three things on there and they are still not approving me. I have a doctors appointment tomorrow to see what we can do. They didn’t give me a reason they just told my doctor.

[lizonaplane 1,604]

You should talk to the surgery center about why the insurance is denying you. The insurance company would normally provide a reason for the denial, at least I think they do. And you can call the insurance company and find out the reason. I have had to deal with insurance companies for a chronic illness and it's really a PITA but you can always EVENTUALLY find out why something is denied.

[pdc1605 40]

Question: what is the difference between a predetermination letter and getting approval for the surgery? I called my insurance and the gal just spoke in circles! Finally have all my pre op requirements completed.....man, this a job!

[KariLinn 0]

So how did you get approved?

[pdc1605 40]

I haven't....I don't think [emoji848]