Denied!
I just got a call from my surgeon's office saying that my insurance denied me because my PCP didn't write the words that she recommends the surgery. Nope she sure didn't. Instead she wrote that it would benefit me and I would be a great candidate for the surgery. So now she has to amend the previous letter to say that she recommends that I have surgery. They also said that I had not had my NUT consult. Again, they are absolutely correct, but the surgeon's office stated that I am scheduled for 5/2/16. My patient advocate said that she usually doesn't appeal, that it's up to the patient, but in my case, she is going to because they are being too picky. So I am not worried, just a little disgusted because I felt like they had jumped the gun by sending everything before I am finished with all of the pre op requirements. Anyway, I have another wait. That just gives me more time to dot my I's and cross my T's.
HW 330
Surgery 7/21/16
I am very sorry this happened to you. The fact they don't do appeals, but will do one for you is good. I would suggest that you tell them to fax the appeal, not mail it in. That can take longer. Usually, they will do this, but just be sure they are going to fax it and they should get a response within 24 hours if not sooner.
Good luck!
Having been denied twice for bogus reasons I just want to say, don't give up... It's often the case that they deny like this but the good news is they stated plainly what you needed to resubmit and it's not terrible like , losing 10 % of your body weight or more 6 month diets or anything like that. It sounds as if you'll be approved after the office corrects this .... However IF you get denied again PLEASE know that it is your right to call your insurance company and say "I was to file a grievance and get an external review" do not give up , to many people do and that's what they hope you'll do !!
Banded 6/9/09 HW 242 LW 142 Revision 198 m 1 loss 16 lbs 182. M 2 loss 4 lbs 178. M3 loss 6 lbs 174.m4 loss 4 lbs 168. M5 gain 2 lbs 170. M6 loss 7 lbs 163 M7 loss 5 lbs 159 M8 loss 1 lb 158 M9 loss 0 M10 155 loss 3 M11 154 loss 1 M12 loss 2 152 M13 loss 3 149 M16, 17 0 loss M 18 loss 4 lbs 145 (18 months 53 lbs)
I was also denied for bogus reasons, but they gave in on appeal. Keep after them!!
Program Start Weight 346 | Surgery Weight 282 | CW 217 | 5'-6.3"
High Weight 376, about a year before program. I gave up diet pop(and all pop), dropped 30 pounds without trying, and kept it off. Now convinced Carbonated Beverages. Are. Evil.
DISCLAIMER: My posts often have weird typos... Because I use a tablet or Kindle to access the forums despite how much I suck at tablet typing. Apologies!
