Has Anyone Been Denied And Resubmitted Paperwork A Second Time.

[krenee 8]

Well i encountered a minor setback. My insurance company GHI denied my claim. stating that I needed the 6 month diet. I was hoping I could get away with not having to do that. now that I have to resubmit paperwork, I am a little disappointed. Has this happened to anyone. The waiting is killing me...............

[happy1957 138]

Hello Krenee, Unfortunately I was denied two times and then had to do a final appeal. My denial was because I had lost weight and it had not been the required, consistent 24 months of a BMI of 40 or more. Never ever give up! I was worn out after fighting with them for nearly 11 months, but it finally worked out for me and although it' s only been 1 month since my surgery I can tell this is the best thing I've ever done for myself. This venue and the support that you get here will help you stay strong. I wish you the very best of luck....

[Shellyac 22]

You should try to appeal the denial and mention that ASMBS (www,asmbs,org) issued a position paper in March of last year that said that there is no benefit to a 6 month supervised diet. Here is the quote from that paper

It is the position of the ASMBS that the requirement for documentation of prolonged preoperative diet efforts before health insurance carrier approval of bariatric surgery services is inappropriate, capricious, and counter-productive given the complete absence of a reasonable level of medical evidence to support this practice. Policies such as these that delay, impede or otherwise interfere with life-saving and cost-effective treatment, as have been proven to be true for bariatric surgery to treat morbid obesity, are unacceptable without supporting evidence. Individual surgeons and programs should be free to recommend preoperative weight loss based on the specific needs and circumstances of the patient.

It may or may not work but I don't think there is any harm in trying

Michelle

[Leederz 49]

Hey just to chime in I was actually denied twice and had to have my doctor file an appeal through another company to get approved. Don't give up, my doctor was telling me they deny a lot of people before you get approved.

[gmanbat 5,889]

I went through the 6 month diet and was denied anyway. The reason was the psych reported that I told him I was a drug taking hippy in the 60's. It was for 1 1/2 years, I quit and have been clean since. My doc immediately appealed and they approved. It probably was a delay to get us into the new year and higher co-pays.

[Helen the Cat 42]

Best of luck to you with your appeal. My insurance company refuses ALL requests for bariatric surgery! They do no pay $0.01 towards weight loss surgeries. No appeals, no second chances, nothing, no how, no way! So I went the alternate route and paid for the surgery myself. But I am so glad I did it. As of today, I have lost 100 pounds! It is such a wonderful feeling knowing that I finally did something for me, to make me healthier and feel better. Looking better is just the frosting on the cake! I am so happy I did this for me! Hope you get approved! Love and Hugs and Prayers coming your way! Kathy D (Alias Helen the Cat)