Question:
Insurance denied??

First I have United Healthcare Ins...I had a surgery date of Dec. 5 and was told by my dr's office, Dr. Lee Grossbard, that they were 100 percent sure that it would be approved..I called the office twice because it is getting so close to the 5th..they still told me no problem they were just waiting for insurance but they knew it would be approved...I waited until today to call back and their office is CLOSED UNTIL next monday...SO I called my insurance and they said it had BEEN DENIED!! I am so confused I don't know what to do..I have to have the surgery this year for my insurance to pay 100 percent...I am so depressed I could kill myself....PLEEEEASE HELP!!! Diane    — DianeLuvsflowers (posted on November 26, 2008)

November 26, 2008
1st call back UHC and demand to speak to the superior or MD that the clerk answers to, tell them that the surgery in scheduled for 12/5; ask what other paperwork they need what is missing. Insurance companies do this every year in Nov and Dec "they say that the do not have the funds". They are also hoping or worried that come the new year that you will have another insurance. There was a woman I had gotten approval for surgery, she had cancer and other health issues; but the time she got her heart doc's ok the insurance said no that they were out of funds. Well I did alot a screaming, told them that I was going to the media. She got her surgery on 12/23. You just have to stay strong and keep talk to your insurance and Precerter at your Doc's office. File an appeal and let them know you are contacting your state insurance office to file a complaint.
   — dc10pilotswife

November 26, 2008
I agree with the above, also, I would get an attorney that specializes in bariatric appeals. From my understanding, it costs between $500-$1000 and well worth the money. Sometimes, somehow, when the insurance companies get a very strongly worded "legalease" letter, decisions can change rapidly. The squeeky wheel gets the oil.... raise holy heck, call every day, several times per day, get the office manager at the surgeon's office involved and don't stop until you get that approval. Best of luck, Dawn Vickers, RN, BLC, CLC
   — DawnVic

November 26, 2008
Before getting a lawyer, you might want to call back and ask why you were declined. It could be that they are missing a paper or two, and once you fax it, they would change their determination. I've read of many people being denied for "missing info" only to send it and be approved. Good luck...I cannot image how frustrated you must be.
   — Angie P.

November 27, 2008
Don/t give up the same thing happened to me last week si I know just how you feel. My Doctor did a peer to peer and I was appoved. Try that before time runs out. Did they say why you were denied may be something easy to fix. Dianne
   — NovemberHope

November 27, 2008
Diane, Sweetie, please do not give up. I too have United Healthcare, and I had a revision. So, you might need a NEW doctor. Mine and his office was more than happy to work with me. I have to pay only my co-pay, - since dr and hospital are out of my network. $2,000 and they are letting me make payments. Only had to pay $500 prior to surgery last Thursday the 20th. DO NOT GIVE UP make calls do research. I am in Houston, TX and did a Revision to gastric bypass to the RNY. Keep me posted.... Monica Hayman
   — MonHay

November 29, 2008
Whoa!!!! Slow down.....take a deep breath......take another....this is totally not worth killing yourself over. Yes, it is frustrating, but you need to settle down. I was denied my first time, too. The others are right....call your insurance pre-authorization department, and explain to them the situation. Ask them why you were denied, because it may just be that your doctor's secretary forgot to fill out one little part of the paperwork, or something that can be fixed quickly. Then, if you are not satisfied with that person's answer, kindly ask to speak with his/her supervisor about the situation. Be nice on the phone, even though what you really want to do is reach through the phone and wring that person's neck! I found that being really nice and sort of desperate sounding on the phone, made the insurance person WANT to help me. Just keep asking for supervisor after supervisor (everybody there has a boss!) until you get the answers you're looking for. I know these surgeries are expensive, and if you have to wait until next year, you'll probably have to pay your deductable and out of pocket expenses again, but try really hard to look at the your desired end result. Either way, now or after the first of the year, you'll have your surgery, and start your new life, with your new tool for weight loss. Yes, it's frustrating, and yes you're upset (justifiably so!) but you haven't gotten this far just to give up the fight when you're so close to getting what you want! When I was denied, I called my mom in a big panic. I was crying and having a fit. You know what she said to me? "Ok, what are your options? Who do you need to call? How can you get them to see your problem?" After I answered all of her questions, I had my answers, and "amunition" to fight back. Then she said to me, "Now pull up your big girl panties and get to work!" I went from crying my eyes out, to laughing in just a few seconds! So, please Diane, don't give up! Keep fighting for what you believe in, and what you've worked so hard for already. Keep us posted on your progress!
   — [Deactivated Member]

November 30, 2008
Diane...I hope that you are in a better "state of mind" than when you wrote your post. I was also denied originally, but it was just a matter of not all of the required paperwork being turned in. Contact either the doctor's office or the insurance (or both if necessary) this morning. They could easily get this resolved before the week is over. If this still doesn't work, then consider a lawyer. My thoughts and prayers are with you!
   — BrendaMS