  | | 
01-13-2010, 03:50 PM
|
#1 (permalink)
| | Cub Reporter
Join Date: May 2009 Location: Murrieta, Ca
Posts: 94
Weight Statistics 04/2012 Start Date:
5' 1"
Height:
236 lb Start Weight:
231 lb Current Weight:
115 lb Goal Weight:
5 lb Weight Loss:
116 lb Lb Left to Lose:
2.1186440678 % % Lost:
when i lose it Goal Date:
Body Mass Index44.5869389949 BMI Start:
43.6423004569 BMI Current:
21.7266863746 BMI Goal:
Weight Loss MethodOther
|  Denied :(
So I received an email today from the insurance company that I was denied for surgery. I am so confused and feel sad, I have a call into the insurance company right now asking why I was denied. I should hear from them soon and when I do I will post and see what my options are and if I can even appeal it.
Just got off the phone with the insurance company and they are saying that it is not medically necessary. I don't know what that means? I fit all the criteria set by them so why would they deny it? I feel so lost and defeated right now. They said they are going to send out an appeals letter but will the denial letter state why they denied it and if there is anything I can do? If any of you have been denied, can you help me or even those who haven't been denied, some words of advice?
__________________
Sincerely,
Karenmarie
 | 
|  |  | Weight Loss Surgery Insurance | | | |
|
| |
01-13-2010, 06:29 PM
|
#2 (permalink)
| | Cub Reporter
Join Date: Nov 2009 Location: San Antonio, TX
Posts: 75
Weight Statistics Feb 1,2010 Surgery Date:
4' 7"
Height:
160 lb Start Weight:
140 lb Current Weight:
90 lb Goal Weight:
20 lb Weight Loss:
50 lb Lb Left to Lose:
12.5 % % Lost:
Body Mass Index37.1834710744 BMI Start:
32.5355371901 BMI Current:
20.9157024793 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
|
Hugsss, I imagine that is very frustrating. Haven't gotten approval myself, so have no experience to offer, but hope you keep trying and don't give up. From what I have read it seems that appealing and keeping on the insurance company does seem to have some effect.
Good luck to you. Sheila
| |
| | |
01-13-2010, 08:13 PM
|
#3 (permalink)
| | WLS Master Guru
Join Date: Jan 2009 Location: ohio
Posts: 826
Weight Statistics January 5th,09 Start Date:
September 23rd Surgery Date:
5' 7"
Height:
289 lb Start Weight:
160 lb Current Weight:
150 lb Goal Weight:
129 lb Weight Loss:
10 lb Lb Left to Lose:
44.6366782007 % % Lost:
1-2 years Goal Date:
Body Mass Index45.2588549788 BMI Start:
25.0568055246 BMI Current:
23.4907551793 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
 |
I have this gut fealing that some one didnt turn in all your paper work. Maybe its an issue of not showing proper length of obessity in your record despite the fact you may have it documented on something else. Maybe some budy transposed a number on your weight or something. I just bet you its a clerical error. The insurence companies wont go looking for stuff. It has to be all layed out rite in front of them.
During my 6 month pre op diet I typed up notes of what was disuessed at each apt. Then at the next apt I gave a copy to the Dr. I wanted to be sure that 6 months latter every one agreed on what was done and talked about. I also think it showed my dedication to a life style change. I even turned in copies of food journals every month.
Just hang in there untill you hear for sure what their issue is.
__________________
18 pounds lost before RNY
 | |
| | |
01-13-2010, 08:20 PM
|
#4 (permalink)
| | WLS Mentor
Join Date: Sep 2009 Location: San Antonio, Tx
Posts: 1,100
Weight Statistics Liquid diet July 5, 2010 Start Date:
July 12, 2010 Surgery Date:
5' 1"
Height:
323 lb Start Weight:
221 lb Current Weight:
150 lb Goal Weight:
102 lb Weight Loss:
71 lb Lb Left to Lose:
31.5789473684 % % Lost:
24 months Goal Date:
Body Mass Index61.0236495566 BMI Start:
41.7530233808 BMI Current:
28.3391561408 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
|
I haven't even turned in paperwork yet... still working on monitored diet visits so I have no advice. Just wanted to let you know I'll be praying for you that everything will work out~ Hang in there...  | |
| | |
01-13-2010, 08:56 PM
|
#5 (permalink)
| | WLS Master Guru
Join Date: Nov 2009 Location: chicago,il
Posts: 637
Weight Statistics 02-09-10 Start Date:
Feb.09,2010 & Dec.02,2010 Surgery Date:
5' 3"
Height:
358 lb Start Weight:
152 lb Current Weight:
165 lb Goal Weight:
206 lb Weight Loss:
-13 lb Lb Left to Lose:
57.5418994413 % % Lost:
2012 Goal Date:
Body Mass Index63.4099269337 BMI Start:
26.9226505417 BMI Current:
29.2252456538 BMI Goal:
Weight Loss MethodDuodenal Switch
|
I agree,It could just be a mix up,my insurance comp denied me the 1st time said didn't receive dr. note, told me to appeal I did this time they sent records to wrong dept. said I had to get approval from husbands employer contacted them ,they said not true, sent me back to insurance co., 3rd time they said couldn't find my weightloss attempts, 4th time they said denied because my BMI was 40 and under (it's been 50 and up for past 8 years) so I asked them can we start another case file they said sure we will just send it back for approval after a week they called and said they couldn't find any of my paperwork so we sent everything back in.Called today after a week in a half and found out I'm approved ,the insurance comp. does make mistakes and they will not search for anything keep calling, check paperwork and recheck. I think it might have been an error. Don't give up yet. In my prayers and sending you a big hug to get you through! 
__________________ 
Last edited by lost; 01-13-2010 at 09:31 PM.
| |
| | |
01-13-2010, 09:18 PM
|
#6 (permalink)
| | Seasoned Veteran
Join Date: Sep 2008 Location: Mississippi
Posts: 5,198
Weight Statistics 3/18/2008 (dieted all my life) Start Date:
9/30/2008 Surgery Date:
5' 8"
Height:
292 lb Start Weight:
192 lb Current Weight:
189 lb Goal Weight:
100 lb Weight Loss:
3 lb Lb Left to Lose:
34.2465753425 % % Lost:
2 years Goal Date:
Body Mass Index44.3935986159 BMI Start:
29.1903114187 BMI Current:
28.7342128028 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
|
Just ask lost.. She can tell you all about it. Just don't give up. Appeal and call and bother them until they tell you why and what you need to do to get approved. Sometime you just have to push them a little. Keep us posted as to what happens. We are here for you.
__________________   Love to Share , Health to Spare, and Friends that Care!
| |
| | |
01-13-2010, 11:22 PM
|
#7 (permalink)
| | Super Moderator
Join Date: Nov 2005 Location: Tokyo, Japan
Posts: 24,791
5' 5"
Height:
|
NEVER give up.
Also, get your dr involved in this, directly. Have him do a peer to peer talk necessary with the reviewer for the insurance co.
Hang in there, (((HUGS)))
| 
| | |
01-14-2010, 08:40 AM
|
#8 (permalink)
| | Big Loser
Join Date: Nov 2009 Location: New Hampshire
Posts: 167
Weight Statistics 9-22-2009 Start Date:
May 4th 2010 Surgery Date:
5' 7"
Height:
263 lb Start Weight:
167 lb Current Weight:
140 lb Goal Weight:
96 lb Weight Loss:
27 lb Lb Left to Lose:
36.5019011407 % % Lost:
12/2011 Goal Date:
Body Mass Index41.1871240811 BMI Start:
26.1530407663 BMI Current:
21.924704834 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
|
I haven't gotten that far yet. My 6 mth is up in March. My doctors office said I would be fine. But I always have that fear. You've gone this far..appeal and try try. I hope and pray it works out for you. Hang in there!!!
__________________  | |
| | |
01-14-2010, 09:10 AM
|
#9 (permalink)
| | Seasoned Veteran
Join Date: Mar 2007 Location: Floyd County Virginia
Posts: 9,445
Weight Statistics September 19th 2007 Start Date:
September 19th 2007 June 18,2012 Surgery Date:
5' 10"
Height:
363 lb Start Weight:
226 lb Current Weight:
170 lb Goal Weight:
137 lb Weight Loss:
56 lb Lb Left to Lose:
37.741046832 % % Lost:
When I get there again Goal Date:
Body Mass Index52.0793877551 BMI Start:
32.4240816327 BMI Current:
24.3897959184 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
|
Somthing is up. Make the call. Ask them exactly what is not deemed medically necessary. They have to give you a better anwser than that. I agree with the above post. Dont give up honey. Ask them what exactly what deemed you not medically necessary.
__________________ Remember Tough times never last Tough people do... This Ribbon is for our Lady Lisa and all the women that fight this ugly disease. RIP Jerry my friend
| |
| | |
01-14-2010, 09:45 AM
|
#10 (permalink)
| | WLS Master Guru
Join Date: Nov 2009 Location: Indiana, Burbs of Indianapolis
Posts: 877
Weight Statistics Most of my life Start Date:
October 8 2009 Surgery Date:
5' 8"
Height:
342 lb Start Weight:
168 lb Current Weight:
164 lb Goal Weight:
174 lb Weight Loss:
4 lb Lb Left to Lose:
50.8771929825 % % Lost:
Whenever my body gets there. Goal Date:
Body Mass Index51.9952422145 BMI Start:
25.5415224913 BMI Current:
24.9333910035 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
|
I was denied at first.... called Dr. his secretary didn't have all the paper work included in the packet sent in to the insurance com. week later I was approved.
My thought and prayers are with you...
(((HUGS)))
hang in there and don't give up[
__________________  | |
| | | Thread Tools | | | | Display Modes |  Linear Mode | 
Posting Rules
| You may not post new threads You may not post replies You may not post attachments You may not edit your posts
HTML code is Off
| | | | |
So long as you are putting your best foot forward, then, 
