Denied And Annoyed!

[Aimee480 12]

I received a notice from a third party entity informing me of the "Initial Denial Notice." The letter stated I was denied because "No Severity of Illness."

Since my BMI is slightly under 40 I must have A co-morbity, which I do, I have high blood pressure.

My main annoyance is from the lack of communication. The surgeon's office NEVER communicated the denial. I received a letter in the mail. When I called the surgeon's office, the insurance coordinator seemed put-out with my questions. This is suppose to be a top-noch/top-rated program. I have been very impressed up till this point. She made it quite clear that it is MY problem to do all the appeal work, she did her part by submitting the initial paper work, so wiping her hands of it all. When I called the provider, they said to call this other provider b/c they do not handle the claims (BUT your number is on the letter!!!!!!!).

So, after numerous calls, I learned there is one nice person out there. She does not know exactly why I was denied, but she gave me some info for my appeal letter.

I have written my appeal letter, will be calling my PCP to get records of my blood pressure with note of the blood pressure meds I am prescribed. And keep my fingers crossed.

Anybody been through this process could offer words of wisdom/advice, I will be so grateful.

[IMSKINNY 160]

I am sure the ins gurus on this message board will ask which ins you have.

[Kiloalphatango 13]

I received a notice from a third party entity informing me of the "Initial Denial Notice." The letter stated I was denied because "No Severity of Illness." Since my BMI is slightly under 40 I must have A co-morbity, which I do, I have high blood pressure. My main annoyance is from the lack of communication. The surgeon's office NEVER communicated the denial. I received a letter in the mail. When I called the surgeon's office, the insurance coordinator seemed put-out with my questions. This is suppose to be a top-noch/top-rated program. I have been very impressed up till this point. She made it quite clear that it is MY problem to do all the appeal work, she did her part by submitting the initial paper work, so wiping her hands of it all. When I called the provider, they said to call this other provider b/c they do not handle the claims (BUT your number is on the letter!!!!!!!). So, after numerous calls, I learned there is one nice person out there. She does not know exactly why I was denied, but she gave me some info for my appeal letter. I have written my appeal letter, will be calling my PCP to get records of my blood pressure with note of the blood pressure meds I am prescribed. And keep my fingers crossed. Anybody been through this process could offer words of wisdom/advice, I will be so grateful.

That really sucks! My surgeon initally said no to me cos my BMI was under 35, but I said so you want me to go home and eat rubbish until I get to 40 - leading to SO many complications and health issues. After that he laughed and agreed to go ahead (yay!)

So maybe use that argument - you want to improve your quality of life etc, so being told your not big enough for a potentially life saving operation is rubbish etc etc