what do you think??

So, I got denied when my surgeon sent in my information to insurance. I have a feeling he didn't send in the complete details so that might have something to do the denial. I discussed this with my PCM and he said that he thought i was an excelent candidate and that he would personally call both my surgeon and my insurance to get me approved. He said not to worry but I can't help but worry.  Do you think there is a good chance i will be approved if my PCM calls the doctors that are reviewing my case at the insurance?? I really hope so!

I think that is a postive sign that your PCM is contacting your surgeon.  The PCM may have questions to ask your surgeon's office about their program.  I sent my information in and my insurance asked my doctor's office for more information on their recovery program.  I was approved in a week. Don't worry until you have something to worry about.   MM

Cristy, Did the insurance company give a reason for the denial?   Often they just have a requirement that has not yet been met (a physician supervised diet, etc) or they need more information.  If this is the case, appeal is pretty easy and straightforward.   If the denial is based on an exclusion in the policy, things are much more complicated. Best of luck, LR

Yes, the reason for the denial was that in addition to being 100lbs over my ideal weight they required a co-morbidity in order to approve. I have hypertension (which is one of the co-morbs listed in the policy) and that fact was not submited to my insurance. 

Thanks paul!  The only thing is that this is first time i was prescribed a medication for hypertension. I haven't even picked up my prescription yet.  My PCM said he would call my insurance to discuss my deinal directly with the doctor *****viewed my case.  Should i still ask for the print out of the prescriptions filled or should i just wait unitl my PCM talks to my insurance. I feel like my PCM has a better chance of arguing my case with insurace then I do, especially since the dignosis of hypertention is so recent.  What do you think?

Are you talking about a peer to peer review?  Make sure they offer it, and if so, they may only want to speak with the Surgeon.  Also, don't let them push, but make sure you get the name and qualifications of the reviewing doctor.  Usually they're just general surgeons/

Thanks guys! I guess all i can really do is just sit tight and wait for a call :) thats the hardest part!