Access Denied

[bbbanded 70]

So, my new insurance denied my surgery last minute, literally one week before my surgery. Definitely had mixed emotions about the whole thing but I'm living, moms absolutely devastated, she was planning to do it too. I decided to throw my money into some new ink, which is normal at least it's not the foody I considered.

I'm not too worried though, I mean sooner or later it'll happen.

[twi 40]

Good out look. Regroup resubmit

[Caribear 184]

Agreed. Did they say why they denied you? If not, try to find out. Then hopefully you can fix it and appeal their denial. It's not uncommon for them to deny on the first try. After all, they want to avoid paying for any procedures that they can. Don't give up. It's not the end of the road, just a Detour.

[bbbanded 70]

My company got a new insurance on 1/1/12 and they have more requirements than the old one, Amerihealth. But the new one never notified us, all they told us was that they needed to verify the old insurance was going to cover it, and we got that letter, and that it was medically necessary, so we went to our PCP and they sent those letters in.

They sent us the rest of the requirements but knowing my company, they most likely will not cover it.

We are considering various options including self pay via loan, and Medicaid.

[DELETE THIS ACCOUNT! 12,703]

Unfortunately, Medicaid doesn't cover it. Thanks to all the cuts to Medicaid and Medicare, WLS was one Medicaid cut.

Your insurance company DOES cover it. I found the document online: http://medpolicy.amerihealth.com/policies/mpi.nsf/e94faffabc7b0da68525695e0068df65/85256aa800623d7a852578f70066f2fc!OpenDocument

You just need to appeal and give the information they specifically want.

[Violet953 46]

Mis73...Where are you from? I'm in Connecticut and was told over a year ago that my insurance would cover it (medicaid) and then started the 6 month process, have finished everything possible ...even the pre op physical is done. And Medicaid approved me a couple of weeks ago. I have a surgery date on February 8th...so what are you talking about? Is it a different state that doesn't cover it now?

[bbbanded 70]

Amerihealth is what I used to have so I know they covered it but I have Omnicare PPO now. I appreciate you looking it up .

I think it may be state to state, because someone I know that works closely with the company actually advised me to file for it.

[Mck xx 15]

Here in IL, wls surgery is also covered thru medicaid. Thank god!

[Violet953 46]

Yeah Mck xx...that's what I thought! I'm having surgery in a little over 2 weeks and I would know if Medicaid was not going to cover it! Where did you hear that from Mis73? Because unfortunately, your wrong.