Insurace denied now appealing any tips

Now my testing is completed and i have a surgery date the insurance company denied due to past wls 21 years ago!!!! I could scream anyone have any tips FAST

What's their policy on revisions?  What does it say in the contract?

This is what insurance stated.

Coverage is limited to one bariatric surgery per lifetime regardless of insurance carrier at the time of surgery, unless Medically/Clinically Necessary to correct or reverse complications from a previous bariatric procedure.

I had a VBG in 1999 and am getting a revision to DS. They denied me at first then approved me after EGD showed a disruption in staple line.
Check out your insurance policy online to see what it states!!

I had a denial too.  It's fairly common for many insurances to have the "one time" WLS clause.  I appealed with focus on the "medically necessary".  They over turned and approved me to be "fixed" but not to have the DS.  My surgeon (Dr. Keshishian) called the head insurance Dude and had a chat aka as a Peer to peer review; and ALL was approved.

Don't roll over and let it be done.  Go down with a fight if you're going to go down and consequently you most likely will get the surgery you deserve and want!!!!  (DS, right?  LOL!)

Hugggzzz,

I think it all depends on your situation. What is going on with you now. Have you gained weight back? Do you have comorbidities? What does your policy say about revisions. Mine said that they were only allowed if the pouch was stretched and you gained weight back, or if you were having issues with malnutrition or hypoglycemia. I just had my insurance's denial overturned, but wouldn't be able to give advice until I knew what was going on.

ETA: I do know that appeals have to be done in a certain time frame so make sure you don't wait too long.

You can check out my blog for the letter I sent today for my denial. It is on my profile page. I had a lot of help from other OH members on it.

Focus on that medically necessary part. In their eyes, that means BMI of so much.. and co morbidities documented I am sure. I had to actually gain weight to hit my BMI and have the insurance approve it. You just have to play their game.

Good lucK!