What Are The Main Reasons People Get Denied Approval?

[Kiki Von Moonshine 53]

I'm curious. I am starting the process on the 31st. I called my insurance today to see if the sleeve was covered and they said it is if its a medical necessity. So that got me thinking "Hmmm.." so.. I would like to know what are the reasons most people get denied approval? I have no comorbities, but my BMI qualifies me. Thanks a bunch.

[Bypassjourney 88]

I think alot of insurance companies have different factors and requirements for approval. I have Aetna. I got a copy of the clinical policy bulletin on the surgery from their website. I read all 38 pages of the fine print so I would know everything that was required. I called the insurance company a few times along the way to clarify some questions I had. My insurance coordinator at my doctor's office was also very helpful since she was familiar with my particular insurance plan. It can be a long process but I feel it is going to be well worth it in the end.

[circa 333]

The biggest reason is that they don't meet the BMI/Comorbidities qualifications. Other people don't have the required weight loss attempt history, supervised diet, or its just simply not covered.

[Kiki Von Moonshine 53]

The biggest reason is that they don't meet the BMI/Comorbidities qualifications. Other people don't have the required weight loss attempt history, supervised diet, or its just simply not covered.

So how does one show their weight loss attempts? I am trying to get everything together in advance. I never had the extra cash for weight watchers etc, however I have joined gyms over many years, but I don't have actual proof of that. I mean I don't have the records of the payments, etc. I also tried pills, but that was years ago as well. I do have a food journal right now, but I only started it recently.

[Kiki Von Moonshine 53]

Btw that chipmunk avatar is ADORABLE!!!

[circa 333]

So how does one show their weight loss attempts? I am trying to get everything together in advance. I never had the extra cash for weight watchers etc, however I have joined gyms over many years, but I don't have actual proof of that. I mean I don't have the records of the payments, etc. I also tried pills, but that was years ago as well. I do have a food journal right now, but I only started it recently.

typically its by going to your doctor and checking in monthly, being weighed in and discussing your weight loss and him/her having you on a "weight loss plan"

[Kiki Von Moonshine 53]

So I'm guessing losing some on your own prior to surgery is a plus?

[lisahg 9]

As others have said, an insurance company can always find any number of reasons to deny your case. The most important thing is to get a copy of their medical policy that involves surgical treatment for morbid obesity and read it thoroughly to understand all of the required steps and criteria for approval. If you meet their criterion for morbid obesity, you could than make a list of all of the required steps that need to be fulfilled. If you call your insurance company to get clarification on something or perhapes ask their definition of "medically neccessary", always document when you called, the name and employee number of the customer rep you talked to. I feel if you are proactive from the beginning you will have less to worry about when its time to submit for approval.