So I Got Denied Today

[DreamsOfSkinny 53]

So I called again and got ref. number for call stating that I only need 1 co-morbidity and bmi of 35+ for past 5 yrs although the medical Dir. Of Ins. Said I was denied bc I didnt have bmi of 40+. Second issue the insurance chose 2 of my lowest weights for 2 yrs and didnt even mark down for a whole year EVEN THOUGH my dr. Submitted all health documents! I talked to my ins. Coordinator at Dr office today

And she said the insurance is just trying to find anything to not approve me. The Med. Dir. Called their office for a peer to peer at lunch time and left a message with the answering service. When my ins. Coordinator called back the ins. Said the peer to peer was already done. She was livid when i talked to her today. Coordinator said she scheduled it for Thursday an gave the Dr's cell phone to make sure they are reached this time. I am really not hopeful at this point and it'll probably go to an appeal but the coordinator said theres no reason they shouldn't approve me by their criteria bc I meet it all. So I'm just praying! I do have a a follow up appt with my surgeon this Friday which we were hoping to use as pre op so I guess if it gets approved I'll be ecstatic as I'll have pre op appt done and can schedule!!! Prayersssssss

[MrsBenson 29]

My insurance coordinator said the same thing. That they are trying to find any excuse not to approve me. I finally got approved. It was an 11 month process but I've heard people going through it for 3 years before being approved. So don't give up!

[DreamsOfSkinny 53]

My insurance coordinator said the same thing. That they are trying to find any excuse not to approve me. I finally got approved. It was an 11 month process but I've heard people going through it for 3 years before being approved. So don't give up!

Omg!! 11 months! I think I'd pay OOP lol not patient at all

[MrsBenson 29]

Well in order for my insurance to pay I had to do a nine month supervised diet. Then I got a few denials for little stuff.

[rxtine 20]

Well in order for my insurance to pay I had to do a nine month supervised diet. Then I got a few denials for little stuff.

What were the little things you were denied for? I start my 90 pre op nut visits next week!

[DreamsOfSkinny 53]

Well in order for my insurance to pay I had to do a nine month supervised diet. Then I got a few denials for little stuff.

Wow! 9 months is a long time.

[MrsBenson 29]

Well first because they said I had no Co morbids. So my doctor had to write basically why I needed it. Example ... if she doesn't have this she is at risk for diebeties, HBO, cholesterol, ect.) And my insurance coordinator wrote that my insurance covers it with no comorbids as long as my bmi is over 40. Then I got another denial saying I needed my regular pyscologist to give me a clearance even though I already got a clearance from the psychologist THEY wanted me to see. Then I got denied saying I needed a Pulmonary clearance. That took a little more time cuz I had to use a cpap for two weeks cuz they saw I had sleep apnea(minor case) then finally was approved.

[MrsBenson 29]

And yea it was long but. Less than a year of work and now I get the surgery completely free to me. I could never afford this on my own.

[DreamsOfSkinny 53]

And yea it was long but. Less than a year of work and now I get the surgery completely free to me. I could never afford this on my own.

Well if you get it 100% free that's great. I have $2k more for my OOP max but that includes any medical treatments me and my family have so the surgery may cost me like $1500 after any other tests I need.

[DreamsOfSkinny 53]

Well first because they said I had no Co morbids. So my doctor had to write basically why I needed it. Example ... if she doesn't have this she is at risk for diebeties' date=' HBO, cholesterol, ect.) And my insurance coordinator wrote that my insurance covers it with no comorbids as long as my bmi is over 40. Then I got another denial saying I needed my regular pyscologist to give me a clearance even though I already got a clearance from the psychologist THEY wanted me to see. Then I got denied saying I needed a Pulmonary clearance. That took a little more time cuz I had to use a cpap for two weeks cuz they saw I had sleep apnea(minor case) then finally was approved.[/quote']

Congrats on getting approved!! You are inspiration for me to not give up just yet.

[MrsBenson 29]

I just got the call today and am scheduled for January 7th! I have to be there at 11:00am! The bad thing is Ill b on a 2wk diet and I can't drink on new years. But its worth it!!!! 7 weeks to go. And yea its 100% free.

[rxtine 20]

Yay!!

[mike010906 14]

I just got the call today and am scheduled for January 7th! I have to be there at 11:00am! The bad thing is Ill b on a 2wk diet and I can't drink on new years. But its worth it!!!! 7 weeks to go. And yea its 100% free.

Good for you!!! I know you are ecstatic as you should be!!! I was denied because I needed (cardiac and) pulmonary clearance as well. My info was resubmitted to the insurance onTuesday. Now I'm patiently waiting for a yay or nay :-/

[MrsBenson 29]

Well hopefully that will be all and u get cleared. My insurance typically took a week to get back to me.

[Piplula 709]

Good luck and don't give up..mine took 8 months for approval! Glad to stuck with it!