Has anyone been turned down and then appealed it??

I was turned down the day before the surgery was scheduled. We thought FOR sure there wouldn't be a problem as the Dr's office said they usually call it in and get the approval code RIGHT THERE ON THE PHONE. But of course with me it was all different. They turned it down, HEALTHY OPTIONS said they are starting something new. Well I had 3 Dr's send in letters saying it was medically necessary to have this done. What I am asking is... How long after you send in the appeal do you hear anything? With the regular submital we heard in 24 hours now it has been a week and I am wondering what is going on. Any ideas on how long this process should take??? Thanks Lisa

Hi Lisa I am curious what kind of insurance you have? did you ask your company(HRO) about rider for insurance? Kathy K

What are they starting that is new?? Peter

I don't have the same insurance but I was told by Tricare that they have 45 days to respond to an appeal. What you should do is have your Doctor call the insurance company and request a peer to peer review of your case (it's your right to do so). The Doctor meets with the medical director and pleads your case. The medical director has the authority to overturn the decision. It's worth a shot. Erin 277/160/?

I have Healtnet Healthy Options. What they said is that you know have to go to a Dr for 6 consecutive months and be weighed and follow a STRICT Diet and also go to a gym of some sort for the 6 months also so they can see if you can loose weight without the surgery. Arghhh They said that this is new for them and I am likt the first one that they will be starting it with. Just my luck.

Hey Lisa, I know I can't help with your insurance issue, but it's been so long I wanted to say "hi". I'm hoping to get to the next support group- are you still going? I was fortunate to have had my surgery 9 weeks ago. Shortly after we met! I will keep my figures crossed for you!! (((Hugs))) comin' your way. ~Robin