Denied?

[BillieG 81]

Has anyone gone through the months of pre-surgery only to be denied at the last minute? I stress about this because the surgeon told me after I complete the nutritional evaluations and tests they will submit all information to the insurance company to get the final clearance. I just wondered how often this happens, because I figured when I first sign up with my weight and health condition they would deny me in the beginning if I weren't a potential candidate. Thoughts? (My final tests are the end of November and my potential surgery date is January 2)

[☠carolinagirl☠ 18,721]

and if you are approved and a date scheduled, you would have upset yourself for nothing...i know its easy to say, but try not to cook the scrambled egg before its hatched....i am sending positive thoughts/vibes your way

[ndpndnt 5]

The surgeon doesn't have any control if you are approved or denied. Once all the requirements are comoleted and submitted the insurance company reviews it and makes the decision. Unfortunately you are at their mercy. I was approved within a week. Some insurance companies seem to deny the first time then approve it after the appeal. Everyone seems to have their own experience based on the insurance. Just my opinion. Stay positive and don't worry. Good Luck.

[GoingforGoal 1,734]

Hi Billie,

Unfortunately there are a thousand scenarios someone can get denied and it has nothing to do with whether you 'prequalified' or not.

Examples include:

a) a person who far exceeds the minimum requirements, but suddenly gets diagnosed with a condition they were unaware of whilst undergoing diagnostics in prep for surgery. Example may be cancer. This requires the patient to get this addressed first before proceeding w/ the band.

a person who is borderline and cannot demonstrate any comorbidities, or fails to meet sufficient proof qualifying them for approval. For instance, you are BMI 35, no comorbidities and have only been overweight for a year. (again, this is specific to the individual insurance co's and their requirements)

c) arbitrary denial. This is my story. Husband and I went in together. Did all our tests together. Submitted the pw, he gets approved and I get denied. When the doc informed them we were a married couple and we mutually met the requirements, the insurance company approved me. Yes! It's a game, and Yes! it can be played not in your favor. But keep trying.

Most people coast through. If you already meet the minimum requirements there should be no problem. We are talking small percentages of people who pop up with conditions and/or the person who is trying to see if they can get qualified and were not confident they would be approved or not.

Just go through the motions. There is nothing you can do until you get word from the insurance co.

[jcrosland 48]

Billie... I too was concerned about this, we have to go through so much just to get our cases submitted to the insurance, and then it's completely out of your control while they decide. My case was submitted on Monday of this past week, and I just got the call late Friday afternoon that I was approved. It's hard to let go and have your fate in someone elses hands, someone you've never met, and may have never even talked with. Just stay positive, and don't give up!!

[BillieG 81]

Thank you all for your kind words and support. It is as I figured, that there is not much I can do about the approval and to keep doing what I am doing. My BMI is 39.7, which is why I worried. I am JUST UNDER the 40 mark. I do have osteoarthritis in my knee, take blood pressure medication, I am hypoglycemic, and I am being tested for sleep apnea on Friday. I will just keep on doing what I can do and hope for the best. I am glad that "hazel" mentioned appealing, because I didn't know about this.

[dawalsh 919]

Thank you all for your kind words and support. It is as I figured' date=' that there is not much I can do about the approval and to keep doing what I am doing. My BMI is 39.7, which is why I worried. I am JUST UNDER the 40 mark. I do have osteoarthritis in my knee, take blood pressure medication, I am hypoglycemic, and I am being tested for sleep apnea on Friday. I will just keep on doing what I can do and hope for the best. I am glad that "hazel" mentioned appealing, because I didn't know about this.[/quote']

Hi there,

I think a lot of us may have gone through an appeal process but you have more than one co-morbidly so I don't think you should have any problem. Wishing you nothing but positive thoughts!

[khelm32 52]

Yes. I started my 6 month supervised plan, Dec. 2012. I have yet to be approved. I am on my 3rd appeal now, awaiting the insurances response. I ended up having to have a sleep study done as well in hopes that this would get the approval. I meet all of the criteria, but they keep giving more and more hoops to jump through.

[BillieG 81]

Yea, the surgeon did tell me that I have one of the better insurance companies so hopefully they aren't as picky. I think I would appeal one time and if I was refused twice I would be done with it maybe it's not meant to be. But I still appreciate the process and am learning how to improve my eating and exercise.