I've been denied by insurance!!

I cried for two days upon learning I was denied by my insurance company, even though I knew it might happen. I am not sure how to make an appeal and thinking maybe this is God's way of telling me I shouldn't have the surgery. I have submitted my paperwork with Dr Blackstone's office, done the Psych consult, cardiology tests, blood tests, and continued Psych therapy. I believe I have cleared everything and just waiting on a date. Now I am not sure of anything. Can anyone tell me their experiences with this, especially if your insurance has an exclusion clause for bariatric surgery? I am wondering if that means I am out of luck or what. And does Freda usually help with the appeal process? I don't know where to start. Bummed and emotional.

Karen, They usually deny at the first submission, keep your head up. You have put alot of sole searching into even making the decision to have the surgery, its a life changing event. Take a big deep breath and get the attitude that they work for you, not the other way around. Insurance companies usually have a case management area that should help you with the underlying causes for denial. Call them, have a pencil and paper ready and TAKE NAMES and numbers. keep a folder going of what you have done. Yes the Dr's office usually help as they want the income as well. I have been working on mine for 10.5 months now and and still trying to keep the I dare you to deny me attitude. It was submitted in error too soon, suspended, then resubmitted and denied, then they ( the insurance company) lost the paperwork for another 2 months, now its at a medical review board. Keeping my finger crossed all the time. One door closes and another opens....you'll get your open door, just keep looking for the right one. In the mean time practice the smaller meals, eating slower, whats it going to do? Nothing but help you prepare for the future, possible even loose some extra in the mean time, oh darn ;). Keeping the theraphy going is the best thing too! If you use food as a crutch, then your on the road already and you dont even know it yet!

Judy, I have heard this same story many times. Go to the support group Wednesday night and ask advice. You will be surprised at how many others have gone trough the same thing. It has been my experience that SBC does NOT help out with these issues. I would recommend that you buy the book "Weight Loss Surgery for Dummies" This has samples of appeal letters. Also, many folks use a lawyer to draft the appeal. Good luck, Mary

Great idea Mary! And, me thinks that O.H. has a forum for denial help too? Anyone know? I know they used to have a section with legal help and links to lawyers that had samples of appeal letters. Good luck Judy! .....Being in the "business", I know that sometimes a denial is based on a simple thing like a missing page of a medical record or a diagnostic code that has been written incorrectly and sometimes with a persistent Bariatric Coordinator; you can get the little things tweaked easily with a couple of Faxes and the approval letter is in the mail! Keep hope alive and don't give up! Joyce

Karen, Before I went to the seminar for Dr. Blackstone, I called my insurance co. to see if we had coverage, my husband is having this surgery as well. The answer I got was no our plan does not cover this surgery, however, when I inquired further they told me if my primary care doctor gave us the morbid obesity diagnosis, I think my husbands BMI is 41 and mine is 44, and that letter goes into the insurance co. they would approve it. We didn't even have to list all the diets we have been on, my doctor didn't have to write any more letters. Call your insurance co on your own and find out what the requirements are, I think it all depends on how the request is submitted to them. Our Insurance Co. is United Healthcare, and most of all, don't give up! My husband is scheduled for Nov 6th and mine is Nov 29th. I can't beleve you have gone through all the testing without an aproval. My letter from the primary care doctor wasn't anything spectacular so I'm sure your doctor can write one for you. Good Luck girl. Carole