Self Pay reimbursement

Has anyone ever had any sucess with getting reimbursed from insurance after they paid for the surgery themselves? I was officially denied, but sent in additional info - not an actual appeal. I have been told it can take 6 months before they approve or deny again. I don't want to wait. I can self pay now and hire an attorney later to fight for reimbursement, but was wondering if there is any success rate?

I would think that the only way you could be reimbursed is if you could prove that you met all of their requirements for the surgery prior to having it done. I see you have Medical Mutual - they were my secondary insurance and they approved me before my primary (Aetna) did. However, I had called and found out what their requirements were and made sure I had done everything before I submitted to them. I obtained copies of my medical records to show my weight for at least 5 years, I obtained the psych eval., I provided a diet history (did not have to be dr. supervised) and I had been attending Weigh****chers for 5 months at the time and I documented that. None of us ever want to wait, however, unless you have $30,000 to spare, I wouldn't jump in a do it hoping to get reimbursed later because it might not happen. Question...why did they say it will take up to 6 months before they approve? The only reason I can think of is because there could be a policy against applying for approval for the same procedure within a specified period of time. Otherwise, they're obligated to give an answer within 30-45 days. You probably would have been better off to do an actual appeal as they have to reply within 30 days for that. How long do you have to file an appeal??? If you meet their requirements and can send the documentation that they require, I'd file an appeal on the original denial. Good Luck.

Debby, Another thing you might do is just call your insurance company and ask them what their policy is on reimbursement. If they won't cover the wls, maybe you can get them to pay for other things. It might be worth a try. Keep up the fight and don't let them get you down. Hugs Lori