Insurance Denial?

[Toyaboo22 51]

Has anyone experienced WLS denial even when you meet the insurance requirements i.e. bmi, supervised diet, test?

[dexter 205]

It didn't even matter what I did. There is a rider in my insurance that says no bariatric surgery will be covered at all!

So, we cash in a retirement fund and hope ins covers lab work, psych consult, things that can be attributed to other medical needs and go from there!

[Toyaboo22 51]

I'm talking about if your insurance company covers it and you meet all the requirements that they ask for but they still deny you.

[alliecat1095 128]

It didn't even matter what I did. There is a rider in my insurance that says no bariatric surgery will be covered at all!

So' date=' we cash in a retirement fund and hope ins covers lab work, psych consult, things that can be attributed to other medical needs and go from there![/quote']

I have the same rider they will not cover. I am just glad I started this journey on my own. I have found out in the past 3 wks I have / had already or getting treatment..h pylori, sleep apnea and finally one this week that the EKG shows a recent mild (silent) heart attack ...so scary. So as long as I can start a new beginning very soon I am ok with paying for the surgery. .

[soccermomx2 111]

I did not have that problem. I think I have seen previous posts talking about the steps if you are denied. Try searching "denial" and see what comes up.

Is there a particular reason you think you will be denied?

[FDclerical 318]

I've never heard of this but I have the same fear. I read on here one girl got denied from her surgeons office forgetting to send pcp referral. I am extra paranoid so I literally go to all my appointments with the same folder and get copies of my clearances THEN I call my surgeons ooffice to make sure they got it. Just be prepared we came too far to get denied! !!!!

[Toyaboo22 51]

There is not a particular reason why I should get denied. I called BCBS and they said that even though you met their requirements doesn't mean you will be approved. I was just wondering if this has happened to anyone before. Just like everyone else, this has been a long road and if BCBS did try to pull something like this, I would be so upset .

[FDclerical 318]

There is not a particular reason why I should get denied. I called BCBS and they said that even though you met their requirements doesn't mean you will be approved. I was just wondering if this has happened to anyone before. Just like everyone else, this has been a long road and if BCBS did try to pull something like this, I would be so upset .

sorry but BCBS sounds dumb. y would you get denied if you meet all the requirements??? good luck to you i'm sure you will be fine. also ive read a ton of people here have the same BCBS (not sure if depends on the state) maybe reach out and see if any of them heard the same

[Toyaboo22 51]

Yeah, it is dumb if what they told me was true. I'll reach out to others on here to see if they had this problem. Thanks.

[soccermomx2 111]

That is good that there isn't a reason that you should be denied. I had just wondered if they had given you the idea it might be denied. I have BCBS Federal and they seemed pretty easy to deal with. If you have a good coordinator at your dr office they should be able to handle any hiccups that come up.

I think they have to say that nothing is guaranteed. I only met the BMI requirement as I didn't have any other co-morbidities. I know it would be upsetting to come so far & be turned down.

When they submit your things...just call the insurance company regularly to see where it is in the process...

I will be keeping my fingers crossed for you!!! Let us know how it goes!!

[Toyaboo22 51]

Ok, thanks

[KS Fort Worth 86]

I learned from a dentist dealing with insurance companies that sometimes they will deny just to push the claim out into the future a bit, and they subsequently approve on re-submittal. The dentist's office said they had seen that a lot, so it stands to reason that scenario would apply to medical as well. Make sure your ducks are all in a row, and bug the crap out of them! Your surgeon should have an insurance advocate who can help as well.