Got Denied

Called the insurance company to check the status of my preauthorization and they denied it stating that I do not have a life threatening condition that I would need the surgery. My BMI is 45 and I have arthritic joints, depression, stress urinary incontinence, endometriosis, and morbid obesity but they will not approve unless there is a life threatening condition. I have BadgerCare HMO through United Health. I know I can still appeal the claim, but I am not sure if I am going to.  Going to consider loosing the weight on my own through major working out, eating better, and a strict personal trainer. To everyone else, good luck in your journey and I hope you have better luck than me. I will let you all know if I decide to do the appeal.

I am so sorry that you were denied. I think you should definitely appeal because those are all serious ailments and hopefully they will see you aren't giving up and approve you next time. I wish you the best.

I am sorry you got denied as well, but I hope you will search your soul and try again.  My friend got denied 3 times and the squeeky wheel gets the grease!  Get another doctor to write a letter, validate how life-threatening it is, keep at it and don't let them win.  If it something you truly desire, try, try, try again.  Good luck in your thoughts!

I was denied my first try.  Although upset I realize that insurance companies need to "weed through" to see how serious and committment a person is to having this life changing surgery.  In retrospect, I am glad I was denied because it made me realize how badly i wanted to have RNY.  If this is something you really want, don't just stop.  Show them how bad you want this.  This journey isn't always a smooth one. 

Thank you all for your support. I am going to do an appeal. They said I need to have a life threatening condition so I am getting all my medial documentation together from my doctors. I have had kidney stones in the past where I had to be hospitalized. I found out that being overweight can cause kindey stones and that kidney stones can lead to kidney failure. So, I have scheduled an appointment with my urologist on Monday to have him put that in writing. Also got a bunch of other information from other doctors like my OB-GYN doctor. I really want the surgery and I do believe that I need the surgery so now I am going to fight to get what I want. My boyfriend is being great with everything and he is give 110% with everything. Thank you all again. I am going to keep trying. 

I have Badgercare too, with Group Health as my HMO.  I just had my surgeon consult this week and my first nut visit next week.  I am glad you are going to appeal.  The dr.'s assist. told me insurance likes to deny so they save money.  Don't back down, get that surgery if you want it and sounds like you do.  Life threatening condition needed?  Being severely overweight is a life threatening condition in itself isn't it?  I would think so! Good luck with your appeal, keep us posted. Beth

Hey everyone. I am going to appeal their decision. I got the letter today and it states not medically necessary. Am I wrong but isn't morbid obesity a medical condition? Does anyone know where I can get information online that states that morbid obesity is a medical condition? Also, if anyone has been denied and appealed what information did you present? I am going to see the urologist Monday to get his point on kidney stones and kidney failure resulting from being obese and having him put something in writing to use as an appeal. I am also going to have Dr. Georgan write a letter stating that morbid obesity is a medical condition. I will keep everyone posted as to what I find out. Getting all my medical records together that is for sure. 

I got the book WLS for Dummies.  In the book she has examples of appeal letters and how to go through the process.  You might be able to check it out from the library.  If not let me know I just live in Neenah and have Dr Wasco.  

I found in the Medicare handbook, which is online, that WLS is paid for by Medicare if you have one of several medical conditions. Obesity is listed. I believe MORBID OBESITY  is a step  above EXTREME OBESITY,(my diagnosis).  I do know that obesity had  more than three degrees of severity.  I hope that this helps you. If you go to the medicare.gov  website you will find the booklet on line. Medicaid follows  Medicaid guidelines. 

I just got that book also and have found it to be a great resource...and easy reading.    Worth the money.