Next step after first Denied request of surgery..

So i was denied the surgery thru my insurance as i said in my last msg.

I called my health insurance, since my surgents office was acting kinda lazy and plain out told me oh well try to get another health insurance or i was offered the option of paying out of pocket for the surgery.. Uh! Really! So i decided to call my Health Insurance, they told me my surgent should try to do a Peer to Peer and give a try to get approved. 

Now the waiting game begins AGAIN! 

Feeling discouraged and let down. :( 

I am sorry to say,but I doubt that  Peer to Peer would make the insurance cover the WLS if the policy you have excludes that coverage. 

The doc office is right.. you may need new insurance.. or opt to self pay. 

I can't see your surgeon doing a peer to peer with the insurance co. If WlS is excluded. Doing a peer to peer isn't going to make them cover something that you aren't paying for in your plan. 

Unfortunately,most surgeons choose not to waste time trying to get approval for those of us who don't have the coverage to begin with. Nspeaking from experience here. I self paid for this very reason.

Thank you ladies for the replies.. On to find another health insurance it is.. Patience Patience.

Is your insurance  Keystone Health Plan East or is it another Keystone plan? 

Yes that's my insurance.

I did a little digging and I found a 4 page pamphlet on what is covered and what is not for Keystone Health Plan East.  On page 4 it lists SERVICES THAT REQUIRE PRECERTIFICATION and obesity surgery is one of them.  Here is the link scroll to the last page and you will see it.  http://www.ibx.com/pdfs/custom/psers/medical_plans/keystone_hmo.pdf

Also, in the not covered information obesity surgery WAS NOT listed.  You may want to call the insurance company and get ahold of a manager and discuss what is going on. 

I don't know if any of this is going to help you, but it can't hurt to try.

I know what it is like to fight for the surgery as I fought for over 6 months to get my revision  and my insurance did cover it, but they kept stating it was not medically necessary.  After three appeals/denials and a peer to peer the national appeals unit took over and approved the revision surgery. 

Thank You for your time in looking this info up. I will review it and call tomorrow.

Thanks again. Blessings

Cigna denies the first two rounds usually. They usually approve it with the peer to peer. Most companies will approve with a peer to peer.  If he won't bother to call, find a new surgeon

I had had a BMI of 52 originally and was denied the first two rounds.

I'm no insurance expert but if your policy does in fact exclude coverage and you will have to wait to change, I think you can do some critical things while you wait - and get ahead of the game so you are ready to roll January 1.

1) go to your PCP and ask him or her to put you on a medically supervised weight loss plan.  Do monthly weigh ins and so on. Something like this will be required to certify for surgery anyway, so you can start now and you will have 6+ months of weigh ins preserved in your medical record. This assumes the visits or program is covered or has a co pay that is somewhat affordable to you - I know it's expensive but you put this period of time to good use so you will be ready to submit for approval when you do have coverage. 

2) research all the medical insurance options available in the marketplace now.  Find the ones that cover surgery (and as much of the testing as possible - see all the notes above).  This is complicated and will take time, so use the waiting period to get informed! 

3) save some money for the co-pays and deductibles. If you don't need it for WLS you will have a jump start on your plastic surgery savings account! 

seriously, good luck.  Even if you have to wait you can put the waiting period to some good use.  Hang in there.

christine