Denied for "not medically neccesary"

Okay...so I totally expected to be denied. But not for that reason. How silly is that! They said I can't appeal until I get my denial letter. In the meantime, my surgeon cancelled my surgery date. IF (big IF) I get approved my surgery now won't happen until June or July. Dang it. Please keep me in prayers. Thanks y'all for letting me whine.

Wow I am soooo sorry. That is disappointing.  My BMI was 36 but I did have sleep apnea, high cholestol and asthma.  What is your BMI? And do you have sleep apnea? If you have never been testing I suggest you get tested....most overweight people do have it and that in most cases deems it medically necessary to have surgery.

I suffer from the following: hypertension, dyslipidema, hypovitaminosis D, cholelithias (gallstones), gastroesophageal reflux, fatty liver disease, Degenerative disc disease, carpal tunnel, osteo arthritis, depression, asthma, metabolic syndrome, heart arrhythmia and obstructive sleep apnea. My bmi is (gulp) 48.4. Mexico is looking more and more inviting...

in canada, you would have been approved on your BMI alone.

sounds like some notes are missing from the paperwork that was submitted. call the surgery center and talk to the insurance person that submitted claim after you get your paperwork.
Sounds like something was not submitted.



Tamara

 I think you have plenty to qualify you.
Something stands out to me though. You have osteo arthritis and degenerative disc disease. Do you know that after Rny you can no longer take NSAIDS? Do you have a pain plan in place? Have you considered sleeve or DS so you could take those meds?
Deb T.

That's a shame!  Could your primary care physician write a letter of medical necessity to your insurance company (with a copy to your surgeon) as an appeal?   I'm angry for you!!! 

Thanks sweetie! I am going to ask my PCP and my cardiologist to write a letter. My psych doc is going to as well. Its just crazy. I expected it..but not with that reasoning. I see your surgery is soon. Awesome!!!! Good luck and I will keep you in my prayers.

 What was the reason they denied you? Sounds maybe like they didn't have all of the supporting documentation, or do you not have a history of trying to lose weight on your own?

That is probably it. I will know more when I receive the letter. My case manager said she couldn't give me any more info than that. I am trying to be positive. I know it is fairly common for insurance companies to deny the first time. Thanks for your thoughts.