Amanda1038

I started the goal to weight loss surgery almost 3 months ago. Everything was rolling along smoothly. Me and my surgeon was on the same page I lost almost 40 pounds on the diet before surgery proving I can and will keep the life style. The date was set for November the 4th and we thought everything was checked and crossed. I did everything they asked of me and my dr said I was the perfect candidate for surgery. 2 days before surgery my Insurance send my doctor a denial letter. I will attach the letter to the post. Now I want to appeal but I'm confused on how I do this. My Insurance said to send appeal letter to them. What should I put in my appeal letter I would appreciate all the help and suggestions.

Thank you for the replays. I will call my dr again and see if he has advice this is just confusing as hell right now. I will keep y'all updated

The psych clearance was worded that I did pass but there were signs of severe depression. That could counter react the results of the surgery. This is why I am confused. My insurance is saying I need to send an appeal but my surgeon says to make an appointment with the psychologist. As to be medical necessity I have done everything on that list except Counseling. So do I make a appointment and do the appeal or do one before the other?

I went back to my dr yesterday. He seems to think its the way The results of the Psych evaluation was worded. The last part of that letter about not being educated is also confusing because I went to the seminar and I am very much educated on what the surgery will do and what the lifestyle change will be after. So this is why it is confusing

The denial letter is a bit confusing but if I'm reading it right it was on grounds of depression and having acid reflux disease. Both thing I made clear in the beginning to the whole bariatric team that I have been seeing. I have had depression for years but it's under control with medicine. My dr did not see a reason why it would be denied.