What do you think this means?

For those of you who've played the insurance game, or are just familiar w/it, what do you think of this.  My insur (BS/BS GA) says in their policies that they consider the VSG experimental & not medically necessary.  But if I call an agent and ask if it's covered, they ask me for the insur code and proceed to tell me it is covered.  So I've never really known if my insur was going to pay for this or not.  Well I have a date of 6/16, and it's still w/the insur co, so we're still just waiting.  But yesterday my bariatric coordinator got a letter from my insur saying they wanted something showing I've been to my PCP for this issue, and that he feels I would be a good candidate for bariatric surgery.  (Actually, I have a PPO so it's not really a PCP, but at least my family dr.)  So today I went to the dr, he was great, and tomorrow all the notes from today should be on the way to my insur co.  My question is, doesn't this seem like a good sign??  I mean, if they were going to deny me and just say they don't cover the VSG, wouldn't they do that rather than wasting more of their time requesting info they don't really care about since they would be denying me anyway (not to mention wasting my time, but I'm sure we all know that the insur co doesn't give a flip about our time)??  I was just hoping for some positive feedback, but if anybody knows if this just doesn't really mean anything, let me know, because I'm very big on just knowing the facts and not bull****  So what do you think??     *Angel

Sounds to me like an excellent sign! I would think they could have denied you without the PCP letter of necessity, so it appears they just want a complete file so they can approve! Good Luck in your quest! April in Sacramento

Their request for information means nothing. I just got a denial from UHC on a patient that has an exclusion on her policy for WLS. Funny part is UHC had her stuff for 6 weeks, and they had asked for her 5 year weight history. I would think they would have checked to make sure it was covered, right? Nope...they didn't, then dragged it out by asking for more info! Good luck!

Insurance companies like to play the stall game.  Cigna had said they lost the paperwork 3 times when I applied for my first surgery.  I am now getting ready to submit for a revision.  Good luck and don't hesitate to hire a lawyer if you need it.

Thanks for all your input, but just wanted to update that I did get my approval today.  We submitted to the insurance on Fri, May 30th, they immediately asked for the information I mentioned above, we got it back to them this past Mon, and today it was approved.  Not even 2 wks, and that was WITH a req for more info (which I didn't have in place and had to work for over the course of 4 days).  So I'm pretty excited.   Thanks again!! *Angel

Great news!  I think the insurance companies in general are going to be having a real hard time getting away with a blanket denial  as time goes by.  The facts just aren't in their favor.  I do think they try to jerk you around so you will give up... So stick with it everybody!!!   Congrats Angel!