Insurance Rejection!

billiesosilly · June 26, 2006

I have been denied by my insurance company b/c they say that it is NOT medically necessary and that I have not done enough "physician controlled dieting". I have done almost every diet imaginable but b/c I did them on my own it is not good enough. I have a BMI of 52! I am 340 lbs however otherwise, pretty much healthy. I am NOT diebetic, nor do I have high cholesterol, I do have sleep apnea though. I am at my wits end with them, any advice?

Thanks!

FunnyDuddies · June 26, 2006

Do a 6 month supervised diet with your doctor, and while you are doing that appeal appeal appeal. Have your doctor send in a letter to them stating that it is medically necessary. If you don't have any comorbidities, list the ones you are border line on. If you do have them, state them very clearly and show that it means the band is medically necessary. Just keep plugging away at it. Unless there is an exclusion barring you from getting it covered, you can continue to appeal till they approve.

kellbelle · July 8, 2006

Billie, Hey,howdy,hey!

I was so excited to find someone close to me. I also have Dr. Hung!(Although I'm living over the river in C.B.) I used to have BCBS/state of Iowa and they wouldn't cover no way no how. Now I have insurance blues of my own.:cry I was soooo depressed when I got my rejection letter.I now have uhc and they have been a nightmare to work with so far.No one ever gives a straight answer.It's so frustrating!

billiesosilly · July 13, 2006

Hi Kellbelle,

Don't get discouraged...........fight fight fight!!!!!!!!!! I have written an appeal letter and had 2 of my Dr.'s submitt letters for me. I will fight until they approve me! I have Midlands Choice Insurance. If you need any help or advice let me know. It is cool that you are a Dr. Hung patient too. Why Dr. Hung and not an Omaha Dr.? I was told that there is a female Dr. in Omaha that is awesome, I can't think fo her name though. Talk to ya soon

~Billie~

ladysplenda · July 14, 2006

Both me and my daughter got turned down three times.BCBS.

After three times the insurance company may have to go before the insurance board for a review. Make sure you have done everything right to get approved. Keep notes Names, dates and times of who you have talked to.Very important.

I called and ask for a supervisor and she helped me get approved. We saw a nutritionist for a year once every three months. I was banded in December and Mandy March.