Denied by Insurance- SO BUMMED!

Im sooooo depressed! I got a call from my surgeon's office Friday afternoon. They said my insurance (GHI) denied my surgery. Said it was because I didnt have 6 months of dieting under a doctor's care. I dont understand why they require this. I have 2 friends who have had the surgery, both have GHI insurance, and this was not a requirement. One of them just had surgery in August. My surgeon's office sent in an appeal using 3 months of visits through them, and 3 months prior to them using the doctor that referred me. My surgery is supposed to be jan.5th. Im so disappointed. I cant believe I may have to wait another 3-4 months now. Uggh! Anyone have any ideas??

Karen, I am sorry that you are going through this right now ~Hug~ I know it really stinks, I had GHI when I had my surgery and I had to wait the 6 months while weighing in with the PCP and a Nutrionist, what a waste of time for both of them and myself but it had to be done for GHI to even look at the file! I know others that had to get a lawyer because they did not want to wait the 6 months, they won but at a cost that I was not able to lay out. Hang in there hun and maybe your surgeon can get it appealed but also start on your weigh in's so you will be in the process already. It will happen when the time is right, believe in that! I know you don't want to hear that right now but it will!!!! Things always happen when they are meant to even though it stinks for us at that time and we have a right to be upset and depressed! ~Hugs~ It will work out for you, believe that.... Take care and please try to have a great holiday! Debra P

Hi Karen I had the same problem with GHI. I had to provide them with at least 6 months of supervised diets. Luckily I had the information from my pcp. On the other hand, my sister had GHI but she worked for a private company and she did not require 6 months. She was approved on within 3 days. I am quite sure everything will work out for you. If GHI is not willing to accept the 3 months with your surgeon and the doctor that referred you, make an appointment with you PCP and start your 6 months weigh-ins. It may seem long, but its not. Don't be discourage. You will win this and no one can take it away from you. Glenda

Karen, I also have GHI (HMO, Federal) and I'm nervous that I'll have the same response. I am 1 test short of clearing all pre-op testing and should know something in mid-late January. I've been doing monthly weigh ins w/my PCP since Oct anticipating the 6-month history requirement. Please keep us posted on your progress with GHI and what they are requiring. I'll do the same. Best of luck to you. Debbie

Hello everyone...thanks for your responses and your support. Im still waiting to hear if GHI will accept the appeal. I go see my surgeon tomorrow to go over everything and have the pre-admission testing on thursday lol Not sure how all that is going to work out since i dont have an approval from the Insurance yet but..... If worse comes to worseI will have to reschedule the surgery for March. I know it isnt that long, but it feels like forever. I waited 2 years to do this, been through all the requirement tests, lost the weight i had to lose, quit smoking, and now just have to sit and wait. Very frustrating!! lol. Debbie...a friend of mine also has GHI and was approved in 3 days...she had her surgery in August. Her doctor said with GHI it was all a matter of how the Dr. wrote the paperwork, so hopefully your doctor is familiar with them and knows what to do. I will keep my fingers crossed for you! Keep in touch and let me know how you make out. Thanks again everyone. Karen