I Need Support Right Now My Insurance Wont Cover the Procedure

[KMP85 11]

Hi All,

So I am ready to set a date for my surgery! I have had all my pre op testing, everything was covered and went through without any problem. So I got my letter of medical necessity from my PCP and she is all good luck. My company just changed insurance companies at the fist of the the year. So I signed up for the comapny policy and really had no questions regarding surgery since they thought it covered it. Well I got a call from my surgeons office this morning and my insurance won't cover my VSG. My surgical coordinator told me the doctor will do the surgery for free since I work with his Mother and thats not an issue but I would have to pay the hosptial. I am trying to look into a charity fund for my surgery. What we might have to do is give me a band for a few months and then when I get a new job revise and go to a sleeve. I know it stinks but I am determined to have this surgery no matter what! My altertnate plan is to work with the bariatric dietician or work with weight loss doctor since the economy is so bad and I can't leave my current job. I wish I was still on my old insurance because it was not an issue. I have Anthem Blue Cross Blue Shield of Ohio they will pay for all my pre op tests, pay for all my post op care but won't pay for the surgery? What is that? I am willing to put the money up front or even ask a family member for a loan. This will happen but in the mean time I need support and encouraging words.

[PeteO 3]

My advice ... search this forum for information about appealing the denial. It seems that some insurance companies rubber stamp a denial on the procedure, but when pressed will approve it. Several folks on here have gone through this process.

If you want it bad enough, it is worth exploring these options. There are still open doors.

-Pete

[NikiS 31]

I agree with Pete. It's not uncommon for insurance companies to deny you the first time your doctor(s) submit your paperwork. It's great that your doctor is willing to do the surgery for free but your answer in not only contingent on the type of coverage you have but also on the tenacity of your physician. He/she should be willing to fight this negative response for you -- especially if you meet all of the medically necessary requirements to have the surgery.

I wish you all the best. Please keep us posted.

Niki

[JimmyGotSLEEVED 270]

Yeah, everyone is right appeal, appeal, appeal and if that does work switch insurances.

[doggz109 41]

This makes no sense? Why would they put a band in you and then revise to a sleeve within a few months? If they can go in and do a band....they can go do a sleeve.

You need to go through the appeals process with your insurance company. Most will now cover the sleeve.