reese711

So I got my second denial last week because 1. They need proof my obesity is not endocrine related, easy enough. I just had normal thyroid levels drawn last month. My swallow test showed mild gerd and they want that treated. Also easy, my pcp called in a script. My first denial was because I hadn't participated in the 6 month weight loss program and had not done upper gi testing. My insurance coordinator calls me today and says I need to re do the 6 month program because in the 3rd month I gained 2 lbs. overall I lost 14 lbs from initial weigh in to my 6th appointment. Anyone else have this happen to them?!?!

So I got my second denial last week because 1. They need proof my obesity is not endocrine related, easy enough. I just had normal thyroid levels drawn last month. My swallow test showed mild gerd and they want that treated. Also easy, my pcp called in a script. My first denial was because I hadn't participated in the 6 month weight loss program and had not done upper gi testing. My insurance coordinator calls me today and says I need to re do the 6 month program because in the 3rd month I gained 2 lbs. overall I lost 14 lbs from initial weigh in to my 6th appointment. Anyone else have this happen to them?!?!

What are the reasons for your denial?

I'm in Nebraska. I kind of wonder if the insurance coordinator doesn't really know what she's talking about. It's all very frustrating. I just keep fighting them.

I have blue cross blue shield. I'm just going to do two more months so that it shows 0 weight gain the entire 6 months. I don't want them to have any reason to deny me again. At this point I've been jumping through hoops for 7-8 months there is no way I'm stopping now. Over 2000$ in and down 22 lbs as of this morning. Not happening. I'm determined to get this approval!!!!

I'm just going to do two more months so that it shows 0 weight gain the entire 6 months. I don't want them to have any reason to deny me again. At this point I've been jumping through hoops for 7-8 months there is no way I'm stopping now. Over 2000$ in and down 22 lbs as of this morning. Not happening. I'm determined to get this approval!!!!

What were the reasons they denied you for? I'm on my 2nd denial & just keep hoping it will be overturned.

Initial appointment with surgeon was last august. I was told all insurance requirements at the first visit and completed all of them in a little over a month. They told me my insurance did not require the 6 month supervised diet and submitted my paperwork. It was denied because I did not have 6 months supervised diet and upper gi scope done. While they appealed it I just started the 6 months of visits and scheduled the upper gi series. My last appt with my pcp was the middle of feb and I was down 10 lbs from my initial appt. they submitted my paperwork again with both things they required in my initial denial and today I found out I was DENIED again. Because I am hypothyroid, because my upper gi series showed MILD reflux, and because I lost 10 lbs in my 6 month supervised diet they said I'm able to lose weight with exercise and diet. I am very annoyed, I politely said to the insurance rep this is a covered surgery under my insurance plan, I've done everything you asked from the las denial and you are still denying coverage. I'm confused.... they replied you are welcome to appeal. Ughhhhhhhhhhhhh! Frustrated.

One way or another my insurance is paying for this surgery. I meet every qualification they have. Sooner or later they will get sick of me and approve me.

I am waiting for the office supervisor to call me back.....of course she is out til Monday. Bummer

I am on synthroid.....my last blood work showed very normal levels for my thyroid. It's been treated for more than a year now.

I wondered about that, just wasn't super excited with the idea of multiple organs being manipulated in surgery. I was planning on asking how difficult it would be to switch surgeries after I've already submitted for approval....the surgeon did mention if reflux is bad bypass may be a better option.....

Sleeve surgery..... my bmi is over 40 and I have hypertension. I've met all requirements and done everything they've asked. Now they want documentation that my obesity is not endocrine related and want my mild reflux treated..... which is weird cuz it's not bad enough to need treatment.... I'm waiting for my bariatric office to call me back with the next steps. I'm about to file a complaint with the state commissioner because this is a covered service and they are denying me for irrelevant reasons. Insurance is the most frustrating thing. Why I pay thousands of dollars a year for them to deny coverage over and over again.