My Insurance was denied....now what?

keala
on 10/3/08 2:07 pm - Honolulu, HI
I have really been hoping to have WLS, but they have denied my insurance.  I am planning to appeal, but can anyone suggest a surgeon who will take a self pay?  
mewiltom
on 10/3/08 2:44 pm - Champaign, IL
 They should not have a problem with someone that is going to self pay. I would appel first and see if the insurance company changes there mind


I thank god im almost on the other side.

susie64
on 10/4/08 10:23 am
Definitely appeal.  First find out what criteria they denied you on.  I just read about a lady that used obesitylaw.com and had great success with them.  I heard their fees are very reasonable - $500 or less.  Use them if you need to.

Highest Wt 278/Surg Wt 246/Current Wt 148.6/Goal Wt 145 (initial goal)   
LEOBARS234
on 10/6/08 9:24 pm - duncansville, PA
I was denied my first time too.  Check with your insurance and find out why. YOu have to meet the guidlines.  Some people have tried for this surgery and didn't weigh enough.  That would kill you.  As long as you are 100 lbs or more overweight there is a lot of avenes to take to get approved.  If you have any other medical condition that has to be noted your dr has to put the paperwork the right way.  I was told by my insurance rep that they are not dr.s have it put in laymen terms and explaine y this surgery will benifit you and help you to live healthier.  Insurance companies pay for this surgery because it is cheaper for them if we are thin in healthy than if we remain heavy.  In the long run it costs them way more money. I would definetly check your insurance and dr.  YOu may need another dr to try. My 1st dr didn't have much experience with this so she didn't put the paperwork the way the insurance wanted.  I went to the surgeon and they got forms for my dr to fill out and submitted the paperwork the second time and it flew through.  My drs nurse is on 1st name basis with the insurance company she has done this so much.  she is good at finding loop holes.  thats who you need on your side.. don't wast your appeals make sure everything is thorough. It took me so many ups and downs to get this approved.  I am only the 2nd person under my hubbys insurance that has tried for this and both of us were approved after the paperwork was put the way the insurance wanted it.  My 1 insurance didn't have any requirements but my other required a 6 month weight loss that is a good idea anyway.  It gives us time to make sure we want this and that it's right for us.  Our lives will drastically change or we kill ourselves..

I told my hubby if I die while the insurance company is taking their sweet time sue them. 
Also you can get a lawyer if needed to fight it..

I woiuld check into changing insurance unless you have $30000 laying around u want to spend.  and don't do one of those mexico trips for 12000 thats not good. 

Make sure you are a canadate..

Good luck I know what you feel like my denial was just because it wasn't worded right.  don't quit thats what the insurance companies want us to do.  they want to make sure we are dedicated so we succede they are gambleing on us to stick to the life change..
LEOBARS234
on 10/6/08 9:28 pm - duncansville, PA
I looked at your page if your weight is only 210 you may not be approved.  that is not very heavy.. you have to be able to lose 100 lbs and still be in a healthy weight for ur height.  Most people lose 85-100lbs in the 1st year if you lost that you would be too skinny.  we are to lose more after that.  People do die from malnutrition of this surgery.. Some people can't stop losing and drs have to help them gain.

as far as self pay It's not worth killing yourself if you don't fit the requirement with the surgery.. now a lot that I have read says 80lbs overweight with some other major medical problem that taking the weight off will help
rural_carrier
on 10/8/08 1:39 pm - Florissant, MO
My insurance covers if your BMI is over 40, or there is a medical necessity for the surgery.  GOOD LUCK!!!

 
  
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