Worried about the possibility of insurance denial?

[raspberrylime 65]

I have jumped through all the hoops required by my insurance company (BCBS IL) and have my last nutritionist appointment the first week in August. They'll submit to insurance that day. I'm trying to stay positive and optimistic but the closer we get to submitting the more anxiety I have about not getting approved. I'm curious to hear if anyone has gone through this whole process, did all of the requirements, and was still denied? Did you appeal? Self-pay?

[liveaboard15 1,294]

my insurance wont cover anything bariatric at all. So i was self pay. That really sucked when it came down to pay so i hope you get covered and you probably will

[LaLaBunny 2]

I also have BCBS. I contacted them to make sure that the hospital and procedure were covered and they were. I went through the six month process and all the testing and I was approved by the hospital and given a surgery date.

Right before the two week pre-op diet started, I was told BCBS would not accept my claim.

It turns out the hospital was not a "Blue Distinction Center" and so they could not approve bariatric surgery there. Only Blue Distinction Centers can do bariatric surgeries. I wish they had explained it to me to begin with!

I went to a different hospital (only one of two Blue Distinction Centers in the state of NM) and I have just finished their three month program and I am waiting to see if my claim is accepted.

Wish me luck!!

[Zai2022 16]

I’m in CT. I have BCBS as well. They approved my surgery with no problems. I had to have a drug screen, do three nutritionist visits and pass a psych evaluation. I have sleep apnea and high blood pressure as co morbidities as well. Hopefully you will have a similar result!

[kcuster83 1,505]

The way my process worked:

You submitted a form/questionnaire to the center and if you met all of the requirements they sent you a "online seminar" link to take. On the form one of the questions or requirements was to call your insurance provider and make sure they covered bariatric surgeries and if the hospital was in your network for coverage.

Once you completed the online seminar they sent you a "process approval" and gave you the information to call and schedule your first appointment. The first appointment was with the surgeon who went over the types of surgeries and risks and helped you make a decision as to if you wanted to proceed and with which surgery. If you wanted to proceed the bariatric coordinator came in and went over all the specific requirements based on which insurance provider I had. In addition to what the actual center required also.

It was my understanding they did it this way so you weren't surprised to find out you weren't covered for whatever reason. I guess there is no reason for denial if you have met all of your insurance requirements.

If you meet the requirements of your insurance, what reason would they have at that point to deny you the coverage? Insurance sucks though, so I guess you never know.

I would think it is safe to say if you met their requirements you would be approved.

[ShoppGirl 5,072]

The insurance coordinators are pretty knowledgeable for the most part. If you have criteria to meet for your insurance it means they do cover the procedure. If anything they will just give you more hoops to jump through but They pretty much have to cover it if you meet the requirements.