Denied

[Kelly22 1]

HI,

I received my denial on Thursday. I have Cigna. The doc office ins lady tells me it was denied because at some pt in the last five year history my BMI was between 35 and 40, and not the constant 40 and above. The one time I was able to lose weight in my life of course happens to be within that five-year history. But guess what that loss didn't last! And I thought that was the purpose was to show how you have gained and lost and gained and lost :biggrin: Has anyone else been denied for this reason? And was able to be approved later? I'm working on my appeal letter now. I'll be including family history and going back much longer than five years. Any advice would be helpful?!

Thanks,

Kelly

[BetsyB 9]

Insurance contracts are pretty specific about what they will and will not approve. If yours specified that you had to be above a 40 BMI for a specific time frame, then an appeal likely won't help.

BUT, do read the contract carefully. It may make allowances if you have comorbidities---and your doctor might be able to make a case on that basis.

Failing that, the place to go for help is your HR department. They renew insurance contracts annually, and they're the ones who are really holding the purse strings. If you ask (pressure!) them to make their coverage of bariatric surgery less exclusive, it can really make your life lots easier.

[DodgerFan 0]

Not to discredit the previous poster, I'm sure she's heard that happens, but I've also heard the opposite too. Some insurances will almost always deny people initially, then approve the appeal.

But in agreement with the previous poster, co-morbidities will undoubtedly help. I was BMI 38.5 at my initial visit. I've had acid reflux for years and my surgeon sent me to do a sleep study. I had (very) mild sleep apnea but that was enough.

Good luck!

[Kelly22 1]

Not to discredit the previous poster, I'm sure she's heard that happens, but I've also heard the opposite too. Some insurances will almost always deny people initially, then approve the appeal.

But in agreement with the previous poster, co-morbidities will undoubtedly help. I was BMI 38.5 at my initial visit. I've had acid reflux for years and my surgeon sent me to do a sleep study. I had (very) mild sleep apnea but that was enough.

Good luck!

I'll have to read it all to compile an appeal response. My other problem is that my comorbidity comes from high blood pressure, but it too does not span the last five years. It's just disappointing! :biggrin: When the lady first submitted it, it was "preapproved" in the sense that my ins covers this type of surgery.

[jensmallwood 0]

I'm so sorry to hear this! It must be incredibly frustrating.

Good luck with your appeal-- I'll keep my fingers and toes crossed for you!