Approval question, Reviewing file confused??
I called my insurance last week to ask them a question about the 6mth diet. When they came on the phone I told them that I had a question and he asked me if I was checking on my predetermination? I was kinda of startled because I was told by my surgeons office they would instantly reject it because I didn't do a 6 month diet like insurance wanted. I told her to run it anyway, and then restarted the 6mth diet. Any way I said "Yes, I am checking on that" and he told me that it was in medical review, he said the medical nurse was reviewing it and it could take up to 30 days to get an answer. I asked how long has it be in review and he said 14 days and he told me the name of the nurse.
Now, wouldn't they have already denied me by now because the 6mth diet was not met where not met?? Would it be in review this long before getting denied?
SOME BACKGROUND!
When I submitted my papers, I had the nut, the physc and the surgeons letter requesting surgery. Along with that I also had my 5 year weight history and my dr's list of comborbidities that I have. PCOS, Severe Sleep Apnea, Diabetes. And medical records from each year for the last 6 years plus a page of all the diets I failed and my reports from previous Nut appt.
Looking at my 5 year chart you could tell that in the last year alone I had been into see the dr and weighed at once a month for 8 months, but the documentation is weak.
I am holding out faith that this is a good sign!! Maybe?
Now, wouldn't they have already denied me by now because the 6mth diet was not met where not met?? Would it be in review this long before getting denied?
SOME BACKGROUND!
When I submitted my papers, I had the nut, the physc and the surgeons letter requesting surgery. Along with that I also had my 5 year weight history and my dr's list of comborbidities that I have. PCOS, Severe Sleep Apnea, Diabetes. And medical records from each year for the last 6 years plus a page of all the diets I failed and my reports from previous Nut appt.
Looking at my 5 year chart you could tell that in the last year alone I had been into see the dr and weighed at once a month for 8 months, but the documentation is weak.
I am holding out faith that this is a good sign!! Maybe?
Hi, it all depends on what your insurance is and what your insurance policy weight loss surgery requirements are. Do you have a copy of your insurance WLS requirements? If not, call your insurance company immediately and have them send you a copy. All insurance's are different. Some stipulate the 6 month dieting requirement but are very vague. Others, like mine were very specific - such as I had to be seen by a Doctor, or a certified nutritionist (who was under a doctor's supervision) for my weigh in's, had to have monthly consultation on nutrition, exercise, motivation, diet plan & counseling, blood pressure checks, etc., and it all had to be documented each and every time. I had to loose weight, and not have a gain during my six months.
Get this information from your insurance company in writing - not just over the phone and you should have your answer. Most insurance companies are real "sticklers" on the requirements.
Sincerely,
ragadolly
Get this information from your insurance company in writing - not just over the phone and you should have your answer. Most insurance companies are real "sticklers" on the requirements.
Sincerely,
ragadolly
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