Insurance denied me!!

Well I now have 2 denials. They came back this time with an excuse of not having enough information... but that they would review it again should I want to re-submit. How generous of them!!!! We're talking my life here! I really felt like I had been kicked in the gut, and felt pretty low most of the night last night... but I can't let them win. How do and did any of you handle the denials??? I am really trying to get them exactly what they ask for, and I am beginning to feel like its never going to be enough! It seems as though the insurance companies make it hard on you and drag it out so that you will get tired and quit the fight. Well they haven't come up against me yet!!! I am fighting for my life here. :bow I could use all of the advice I can get, any insight into the wording, or style, or type of appeals that I can make to get them to approve me!!!!

Out of curiosity... what do they require?? Is your surgeon and other doctors helping you get approval? Bariatric programs usually have insurance specialists to sort out what you have to do in order to get approval. Most companies require a BMI of 40 or BMI of 35 with multiple co-morbidities, a 6 month dr. supervised diet, 5 consecutive years worth of medical records documenting your weight, a psychological evaluation, and now a lot of insurance companies require a 10% loss of your excess weight. Fortunately, I didn't get a denial. I made sure I had everything and then the insurance specialist at my surgeon's office checked too. I even submitted my food journal and exercise log from the 6 month dr. supervised diet. My insurance specialist wasn't very optimistic about getting an approval because I was missing a year out of the required medical records, but she submitted it anyways and to my surprise, I was approved.

Count yourself one of the blessed ones!! I wasn't aware that my doctor had already sent my request in again.. I thought we were waiting still for all of my doctor's info to come in. They asked that I have 6 mo. medically supervised weight loss program... and a psych evaluation. That is scheduled for Friday - and hopefully the other information is there now... I know its just a minor setback, but still, it seems as though they are just determined to make it hard on you!

I am so sorry to hear that you were denied, I had an easy approvel process, but then again I made sure that I gave them everything that was required ( 6 month diet, testing, ect ) Did you go over your plan and make sure that you gave them all the required docs? Also there are lawyers that specialize in getting approvels, I can't remember there names, but there on here though, can someone help me out and remember the name? Anyway good luck with everything, I know it's hard, but keep fighting, I know several people that were denied multiple times, and then ended up winning!!! Hugs, Jacqueline

Sonya, Do not give up, if you are not getting help(through the insurance dept at you drs office) then try that. The main thing is not to let them win. Like you said , this is your life. Good luck, Darlene

Hi Sonya, what type of insurance do you have? Find out what they require, such as a 6 month Dr. supervised diet and workout. But keep fighting for your right to a healthier you. I was lucky as I had Medicare/medicade cross over. Now you have to qualify even with Medicare. So I have no idea how frustrating this all is, I can only imagine. But please don't give up. Keep fighting. May God travel with you on this new journey. Kathy

Make sure you have everything you are supposed to have in your appeal. I was turned twice by CIGNA. first because I didnt have the 6 months of dr supervised weight loss. then they turned me down because it wasn't 26 weeks of dr supervised weight loss. WHAT??? My PCP wrote another letter outlining everything and blasted them for trying to geto out of paying for it. I appealed again and requested a hearing and then they emailed me the day of the hearing with an approval. Vandy helped alot too. Get exactly what they need and get your physicians to help you get it all together. and keep appealing, all they can do is say NO or they may decide to say yes if you are persistent. Good luck Marie

Thank you Marie for sharing your story, I appreciate so much everyone's insight, and willingness to help. I pray that you will continue to have sucess in your weight loss, and that you are healthy and happy. God bless, Sonya

I'm glad you're not taking "no" for an answer. They're in business to Take people's money and then pay it out when needed. I know they have to try to keep from paying it out unnecessarily, BUT who's going to sign up for WLS for grins and giggles?? You said it yourself - this is your life, your health. It sounds like things will (I Hope) fall into place when all the rquired information is in place and the proper hoops have been jumped through. Love Dennie

Thank you Dennie for your encouragement! Are you waiting to have surgery, or have you already had it?? This webiste has been so wonderful in helping me learn of what to expect, and questions to things that the doctor's dont really think to tell you. I look forward to hearing from you in the future. I pray that you have a wonderfully blessed day! Sonya