Question:
I have been approved for a consultation with a surgeon. Has anyone been denied after

that consultation? Or does it mean that you are pretty much approved or they wouldn't have approved the surgeon consultation. In other words do the denials come before or after the surgery consultation? I just want to be as prepared as I can be. I just want to believe that they pretty much have approved me if they (the insurance company)let me go see the surgeon and as long as there is no reason the surgeon can find that I can't have it.    — Jill E. (posted on July 29, 2000)

July 29, 2000
I too have had a consult with a surgeon and be told that I was a good candidate, but my insurance company denied me of the surgery that I so desperately need. I would contact you insurance company and ask why and then see if they had any limitations for why they will not cover it. If you can try to appeal it. I am.
   — Chantee R.

July 29, 2000
Be prepared when you see this doctor. Write your diet history as well as physical or medical problems that you may have. Don/t be afraid to speck up and tell him that you are at your wits end and see no other way to go. Hope this helps you get organized! Lots of luck, Charlotte
   — char T.

July 30, 2000
I have Aetna/HMO and I also work for my pcp. Getting the referral for consultation was easy. It is a matter of punching in some numbers on a machine, which includes the procedure code....surgery consult...and the diagnosis code. My type of insurance doesn't necessarily KNOW the type of surgery you are looking at. This is just a beginning step. Depending upon your insurance, it could mean it will be easy for you. If you have one of the BIG HMO's, a consult for surgery is easy to get. You still have to jump through all the hoops to get an approval.
   — Terry M.

May 28, 2001
I was approved to go to the consult. But now I have been denied for surgery..I have Cigna HMO. I am in the middle of my appeal right now.
   — Nikki D.

June 4, 2001
I was approved for the initial consult, no problem. After that they requested documentation from my PCP and requested I have a Physc evaluation to see if I would adhere to the strict post operative regime. Did that and got a great letter from the Physc Dr. to the insurance. Then they denied my surgery. PCP letter was not good. Got another letter with more specific documentation. I am in the process of appealing their decision now.
   — Betty M.