Please please read & help if you can?!?!?

Hey everyone...okay I am in need of some assistance.  I have IA Medicaid and am trying to get this surgery.  I did EVERYTHING they required in order to get approval  and I get a denial letter today stating that I do not meet the set age required by Iowa Medicaid Enterprises in order for approval for gastric bypass surgery?  What does this mean?  Anyone heard of this? By the way I am 25.

 

If this was the case, why didnt the insurance dept in my surgeons office let me know this...so that way if I wasnt even going to get approved on that alone..that would have save a whole lot of time, you know?  Please let me know..any insight on this would be greatly appreciated!

 

Tonya

is there any paperwork somewhere stating what the requirements are?  i think a lot of insurance requires you to be a BMI of 35 with comorbities, or a BMI of 40. A lot approve for the RNY, but what surgery did you want? also, a lot of people have to go through deniles, so don't let that get you down! it just means you can gather more info, more specs, and try again! : )

Don't give up, Tonya.  An initial denial doesn't mean the decision is final.  Many many insurance companies make the process long, complicating and frustrating for a reason - they want to make sure you're a serious candidate... and they don't want to pay!  You have the right to receive in writing their exact requirements for surgery approval including any age restrictions.  ( I haven't heard of age restrictions before, except in the case of minors.) So call them and have them fax/mail you their requirements.  Then, appeal, appeal appeal! Your surgeon's office should be able to help you with this as well as your state insurance board. Heather

Call medicad and ask them to explain the denial. Since you are 25 it could have been an error. As for the surgeons office not telling you - its also your own responsibility to call your insurance and ask about benefits... you have to be as much as an advocate for yourself as possible. Remember that you are one person concerned with yourself and the surgeons office deals with hundreds of patents. Many times customer service gives incorrect or incomplete information... just a sad but true fact... its always good to call yourself and make sure the information given to the surgeon is the same information they give you.

just keep appealing, they will approve it eventually, it's a pain in the arse, but worth the approval.