Afraid insurance will deny my claim

[idream 0]

Hello everyone,

I am new to this forum and I started this topic basically for support. I am at the very beginning of my lap band journey. I am soon going to schedule an appointment with a bariatric doctor to start going over "if surgery is right for me etc." I KNOW i want and need the surgery. Im 5'4 and about 240 pounds, that is not good for a young female. I called my insurance today (federal blue cross blue shield) and they said that they will cover baratric surgery. YEY She gave me a huge list of requirements which includes having a bmi of at least 40, be over the age of 18, proof of a at least 1 year of failed attempts at dieting, 3 months of medically supervised diet through a nutritionist and physiatrist or something like that. There is more but it's pretty basic stuff. Since I have a bmi over 40 i dont have to have any weight related problems (i asked to be sure). But i am just terrified that they will deny my claim and I will be at a brick wall. My question is what happens if i do get denied? will they tell me exactly why the denied it (so I have a chance to fix it?) can someone please share their story of how they were able to get insurance to cover their surgery after it was denied. I am just so nervous, i have a feeling they wont let me get it

PS. PLEASE TELL ME HOW LONG IT TOOK TO FIND OUT IF YOUR INSURANCE WILL PAY FOR IT.

Thank you so much everyone

[mnies 0]

I called my insurance company and I am lucky because they don't require the 6 month diet proof, however, this is something that your employer has to agree to pay more for. I am a teacher, so they figure the less I weigh the better for my job.

If you follow all the requirements it should go smoothly.

I have a pacemaker and was told it would be okay if I got the approval from just my cardiologist. Then they said, 2 weeks before surgery, I needed to get an appointment with my primary physician, which I haven't seen in about 1 1/2 years, for a physical. I explained that I have seen my cardiologist more and they let me get by with that. They were very good at working with me at the doctors office because I was getting very upset when they said I would have another hoop to go through.

Just follow through and I think you will be okay. It took me about 1 month to get all the information to my doctor and then get the insurance to approve.

[CiCiRN 1]

I was denied my first time..I jumped through every hoop there was, including a sleep study..twice!!

I was devastated!! But when I called my Dr. they said that it wasn't uncommon to be denied the first time, not to worry..

So I made another appointment, discussed it all with my dr.. and 6 months later was approved.

I just had my surgery on Dec 6.

I can't see where you will have any problems, your ins co covers it, mine however did not. I had to jump thru the hoops to get it pre approved.

Keep a positive outlook, you can do this!!

[HeatherinCA 10]

I have a different insurance, but I don't have any weight related medical problems either, but my BMI is over 40. I got approval really quickly, within a week? But I have an expensive PPO I was even a new client, I got the insurance specifically so they would pay for the surgery. I think overall, they don't want like, moderately overweight people doing it. They aren't gonna spend $10,000 for someone to lose 40 pounds

[cunner 21]

My BMI is about 38 but I have sleep apnea, hypertension, and a few other co-morbid conditions but was denied by Aetna. My first and 2nd level appeals were both denied upholding the original decision. I finally appealed to an independent external review where the decision was overturned. It took a year of appeal/wait/deny/appeal etc but in the end I got the approval. All I can advise is don't give up. If you do get denied I highly recommend contacting obesitylaw.com. Walter and Kelley handled the entire appeal process for me and it cost nothing. Kelley was the best and seemed to say just the right things when the appeal denials came in to keep me motivated to continue to fight the decision.

I started this process exactly one year ago today and will have surgery on Dec 28th.

With a BMI over 40 you will probably not have an issue. Keep a positive attitude and feel sure it will happen and it will. Good Luck !!