Hello everyone. I’m currently in the process, actually nearing the end, of the pre-op insurance requirements. I just received an “INITIAL ADVERSE DETERMINATION DENIAL NOTICE” from Fidelis regarding the REQUIRED medical nutrition therapy appointments (that I already went to).
So my first question is WHY, WHY would they make this a requirement in order to be approved for surgery BUT not cover it? My second question is, has anyone had any luck getting it appealed?
Thankfully, I have the funds to pay for it if I need to but my assumption is that maybe there is others that have Fidelis/Medicaid that can’t afford it. It’s such an odd policy.

I also have Fidelis in NY and if I recall correctly, they covered my nutritionist clearance but not the psychologist clearance. I didn't try to appeal, the same thing happened several years ago with my first surgery when I had Empire BC/BS.

Isn’t it so odd that insurances require certain things but don’t cover them? I’m going to try to appeal it and if they don’t cover it at least I can say I tried.

Reporting back in case anyone else that has fidelis is wondering. They ended up covering it!