Denied!

[jen_1381 446]

I am two days away from getting banded and got the call this morning that insurance denied me! I'm so frustrated. We had gotten pre approval but when the surgeon submitted info he didn't put down I had I uncontrolled hypertension, just plain hypertension so they denied me!! He was granted an emergency review and was promised a conference call by 9 AM tomorrow but if they say no again, I have to appeal which can take weeks. I'm SO close and now everything is all messed up! They said the surgeon will plead my case and do his best so fingers crossed.

[kah1213 311]

Fingers crossed. Good luck

[waitingpatiently 250]

I'm so sorry!! I know that is flustrating!!--My girlfriend an I started this journey about the same time. I was approved rather quickly and she was turned down. Insurance decided they wanted a 6 month supervised diet instead of a 3 month...good thing she took my advise and continued her monthly visits until she got word from the insurance company she only had to go 2 more times instead of 4. She just turned in her packet for the second time and just found out they are denying her again because a PA over saw her visits instead of the actual physican. Thats crazy!! why didn't they mention that the first time? Now she is in appeals her gp doctor said he would sing off on the paperwork, but the insurance said it didn't matter she has to start over! thats crazy!!

[jennifer1 180]

It just makes me angry when something that small gets ppl denied...I mean these ppl do it for a living so they should know exactly what will get u approved or denied when it comes to documentation...ugh..hope this gets straight soon!

[difa 114]

Thankfully my PCP doctor knew they wanted her to see me and not her nurse...otherwise I would have been denied. Most insurances follow the guidelines of MEDICAID/MEDICARE. Which of course is ran by the government.

Good luck to everyone in this thread!

[jen_1381 446]

It's just frustrating that in the beginning, they were very basic. Two comorbidities, BMI of 35, good to go. The WLS Coordinator got it all in writing (thankfully) so they have another arguing point, but now they say the comorbidities have to be uncontrolled by medication. Thankfully (which is so odd to think!) my BP hasn't responded to medication as well as it should and has been high since I was 15.

If I have to wait, then I have to wait, I get that...if it's one thing this process has taught me is patience. I've learned SO MUCH about nutrition, exercise, and what I need to do to be successful. It won't be the end of the world if they deny me, but this tool would be so useful in helping me reach my goal.

If they appeal it, and I have to wait weeks, I'll have to put back on about 15 pounds to get my BMI back up into qualifying range which will be the only truly frustrating part about it all.

[Bamabander 111]

I'm so sorry... It seems like insurance is out to get you sometimes, I know they have rules to follow but dang sometimes it feels like we are circus dogs jumping through every flaming hoop they throw up... I know it will be ok... Be patient! Praying for you!

[shrcumm 953]

That's Crazy I hope you get approved!! Did anything happen yet since the conference and did you find out any detail! I would think that its the doctors fault for not putting the correct information down!!! Please Let me know the out come of this story?

[jen_1381 446]

We had a noon deadline and at 11:50 they came through with the approval!! So it looks like tomorrow at 11:30 I will become a bandster. . Very excited!!

[kah1213 311]

Amazing news! Congrats

[Bamabander 111]

Yay!!! Praying for you!

[dhales 98]

Woohoo!!!!