Just Denied

Insurance companies deny all sorts of things they shouldn't, because they assume (correctly) that most people won't fight it. I had to file 4 or 5 appeals for a knee surgery I needed, they considered it investigational and experimental. I kept sending them reams of paper documenting peer reveiwed studies and articles and requesting the names and credentials of those *****viewed my file for each denial. Took a lot of time, but I got it approved.

I hope you can get the denial overturned. Insurance companies suck. I'm so sorry you're having to deal with the stress.

:( That sucks.

The problem may be that the company or organization you have who purchased the insurance you have if it's private insurance has a bariatric rider that only permits one per lifetime. However, appeals can't necessarily hurt. You might want to call human resources though, and ask if they can confirm what bariatric coverage was purchased.

What you need to do is call the insurance or go to their website and get what's called the evidence of coverage, or a copy of the medical policies. This can be annoying to find, however it will clearly outline what your rights are. A lot of WLS approval is how to code things - even getting labs approved needs specific codes, sometimes.

Insurance plans vary widely depending on riders though. I have BCBS IL and they approved the revision without blinking an eye - but we have a very good bariatric rider where I work. Start with your evidence of coverage and work backward.

If you have to revise to RNY due to GERD, it also does not count as a second stage procedure, typically, but it depends on various states.

Appeals are also worthwhile. So is delineating the costs of obesity versus the costs of surgery. I had one acquaintance literally calculate the costs of diabetic medication, statins, back surgery etc., itemize it, and compare it to the cost of surgery. The insurance company then approved the revision based on this, because the 60k surgery was cheaper than about 600k+ of medications and treatment for obesity-related conditions down the road. This was also quite a bit of work, though, and they literally wrote what was basically a 30 page paper with citations and stuff.

So, you have options. Make lists. Do some research about insurance appeals.

And hang in there, Babette. Don't listen to the snark and don't lose faith. It sucks right now, but it isn't the end of the journey!

You have nothing to lose by appealing. Start the process immediately. There was a section in Weight Loss Surgery for Dummies that dealt with appeals. Do some research and work with your surgeon on the appeal.

Did you have the same insurance for the first surgery?

I am so sorry! Don't give up on getting healthy. Praying that the door opens for your surgery.

I had the same thing happen to me with BC/BS. They sent me a letter, that letter had a code number on there explaining why I was refused. I got on there website, my code number was #53, it had 78 pages talking about Bariatric surgery, on page #56 it had all the reason for qualifications. And I qualified, I did a screen shot of of that page, sent it to my Drs office. A week later I was approved, a month later, I had my surgery. They just didn't wanna pay. Get on their website and do your research. Don't take NO FOR an answer . Good Luck