Who else is waiting on approval?

[BANANA PANTS! 60]

Part of the insurance game is the insurer denying outright initially. They will find any and everything they can to deny deny deny! From my experience as a patient and as a nurse case manager who worked directly with insurance companies, it is a big old game and you just have to keep the pressure on the company. Also, having your surgeon actively involved helps too.

Sleeved 12/17/12 and enjoying the adventure!

[slimmerplt 7]

I also have Cigna my paperwork was submitted and one week later denied. This was last month. The denial letter stated I had not met their requirement for three month supervised program which was true. I thought n was told by surgeons office they would accept weight watchers. Well they do put if supervised by dietician or doctor. Also they stated I hadn't submitted letter from another doctor recommending surgery, Ian's giving clearance. I did have letter from PCP but apparently it was not good enough. I contacted my PCP n she I hope will call cigna to see what is needed. I had originally started a three month supervised program because I thought I had too so this was actually a good thing I will finish that on 18jan. Have to see behavioral, get revised ltr and hopefully will get approved!!

I hope so I'm starting g to eat everything in site n at the rate I'm going ill be 20 pounds by end of January !!!

[jamari 12]

I also have Cigna my paperwork was submitted and one week later denied. This was last month. The denial letter stated I had not met their requirement for three month supervised program which was true. I thought n was told by surgeons office they would accept weight watchers. Well they do put if supervised by dietician or doctor. Also they stated I hadn't submitted letter from another doctor recommending surgery' date=' Ian's giving clearance. I did have letter from PCP but apparently it was not good enough. I contacted my PCP n she I hope will call cigna to see what is needed. I had originally started a three month supervised program because I thought I had too so this was actually a good thing I will finish that on 18jan. Have to see behavioral, get revised ltr and hopefully will get approved!!

I hope so I'm starting g to eat everything in site n at the rate I'm going ill be 20 pounds by end of January !!![/quote']

Well in my case the surgeons office submitted: 3 month supervised nutritionist program, letter from PCP, clearance letter from cardiologist, psychological evaluation, lab results, medical history from previous endocrinologist, my bmi is over 40 and I have high blood pressure and high glucose levels. Do you really think they have a reason to denied me?? I don't think so, what do you guys think??

[slimmerplt 7]

I think as long as u have EVERYTHING then it shouldn't be a problem. When they denied the letter outlined everything required and which requirements were not met. Just wish I had contacted then on the beginning then I wouldn't have been crushed when I was denied. My BMI is 41 and I have high cholesterol n blood pressure but the BMI alone qualifies me. Also my denial is because of two requirements not met. I'm not concerned I know I'll have it all by end of January.

As long as the letters has everything required and ur 3 month weight management program has all required info u will be APPROVED. If not they will deny but will let u know what is needed.

[cms213 119]

Just wondering... I'm meeting with a nutritionist that my PCP recommended and is part of the same medical center as the surgeon. Will that count as my 6 month supervised diet? I'm a little worried because she isn't weighing me and really doesn't want me to focus on the number but focus on the mental part. Between all the other appointments I have I'm weighed all the time but just nervous the nutritionist won't meet the 6 month supervised diet.

[chubilicious 12]

Just wondering... I'm meeting with a nutritionist that my PCP recommended and is part of the same medical center as the surgeon. Will that count as my 6 month supervised diet? I'm a little worried because she isn't weighing me and really doesn't want me to focus on the number but focus on the mental part. Between all the other appointments I have I'm weighed all the time but just nervous the nutritionist won't meet the 6 month supervised diet.

My surgeon provided with blank forms that they use and said any Dr can do this for me. I did it with my PCP and went in every month for 3 months and he recorded my weight, excersize level and nutrition intake which he took my word for . I actually did not loose any weight during my 3 months. Ask your surgeon for the forms i am sure they have it. Good luck

[chubilicious 12]

Well in my case the surgeons office submitted: 3 month supervised nutritionist program' date=' letter from PCP, clearance letter from cardiologist, psychological evaluation, lab results, medical history from previous endocrinologist, my bmi is over 40 and I have high blood pressure and high glucose levels. Do you really think they have a reason to denied me?? I don't think so, what do you guys think??[/quote']

You def. meet and exceed all the requirements. So did i but they came back and asked for another doctors opinion and said that i did not present my supervised diet history. Which was just major BS! Why would u even think about submitting without the history which is a major factor. My surgeons office laughed and said that this us just a game they play. As a matter of fact when my insurance coordinator tried telling the claim specialist to double check the files because it was definetely aubmitted the claim person had no answer but just kept reapeting the same over and over. It is so obvious that they want to give you a run around and i m nit sure hiw they get away with it. Try missing a premium payment and see hiw fast they drop you. Anyways i resubmitted and was approved 5-6 days later.

[cms213 119]

My surgeon provided with blank forms that they use and said any Dr can do this for me. I did it with my PCP and went in every month for 3 months and he recorded my weight' date=' excersize level and nutrition intake which he took my word for . I actually did not loose any weight during my 3 months. Ask your surgeon for the forms i am sure they have it. Good luck[/quote']

My surgeon gave me a form to record my exercise. I'll have to check with my PCP to see if everything will be what the insurance wants. I read on one of these post the they don't actually submit the supervised diet because the surgeon will advised its been completed and on file.

[DreamsOfSkinny 53]

Insurance is definitely a fight! Battle! Ughhhh..... Frustrating so much sometimes. But it's sad when the insurance keeps telling me - just submit a 2nd level appeal and state all of the issues you've had with us so they will be addressed.... I kind of felt like their supervisors were almost hinting to me... just file the 2nd level appeal. So I'm starting on that and hope to get mailed off by Monday. I now have an additional letter for my co-morbidity from a Doctor and have a 2nd Doctor writing a letter supporting the surgery for this other health issue I'm having (and can lose my vision permanently if I don't lose a LOT of weight soon and to keep it off). I've asked my surgeon to write another letter for the appeal as well showing his support.

My insurance is denying me because they are saying I need to have had a MINIMUM of BMI of 40 for past 5 years but my Summary Plan Description does not state those specific wording... even my 1st level denial letter had quoted wording that is NOWHERE in my Summary Plan Description. When I called to ask where this was found insurance kept saying just do 2nd level appeal..... I've reached out to corporate office for consumer affairs for the insurance company for them to look into this as I've had clerical errors from them from the 1st denial letter that were never corrected. I also have a 3rd party that my employer uses to act as "advocate" for me who has reached back out to my employer to find their specific definition they are using for "morbid obesity".

Denial reason- no BMI of 40+ for past 5 years

Summary Plan Description states - I need a physician to diagnosis me with morbid obesity for past 5 years

My HR Benefits Manager states they use industry standard and never gave me a direct answer. Insurance company never gave me a direct answer but by the denial letter and their consumer affairs representative they are stating it is BMI of 40+ and that is standard. Odd as the insurance company has their own policy for bariatric surgery that states morbid obesity is BMI 40+ OR 35+ with at least 1 co-morbidity (which I have) that they use for their fully funded clients (my employer is self-funded so it's really the employer's definition I have to go by). That is my fight right now. I provided tons of "industry standard" that is even found WITHIN the insurance company's own policy stating "morbid obesity" is 40+ OR 35+ 1 co-morbidity.... along with how several of the other big name insurance companies are using for "industry standard". I honestly feel like I can win this as this is the ONLY reason they are denying me.... I had a BMI of 38 and 39 for past 4 years and 40 this year (although in 2013... I'll be 40 again haha! So I need to get re-weighed and submit another 40 number now).

[jamari 12]

Approved. Surgery Date: 01/07/2013. Thanks lord and all of you for your good vibes and support.

[Ballermom 803]

Approved. Surgery Date: 01/07/2013. Thanks lord and all of you for your good vibes and support.

Congrats

[Ballermom 803]

Insurance is definitely a fight! Battle! Ughhhh..... Frustrating so much sometimes. But it's sad when the insurance keeps telling me - just submit a 2nd level appeal and state all of the issues you've had with us so they will be addressed.... I kind of felt like their supervisors were almost hinting to me... just file the 2nd level appeal. So I'm starting on that and hope to get mailed off by Monday. I now have an additional letter for my co-morbidity from a Doctor and have a 2nd Doctor writing a letter supporting the surgery for this other health issue I'm having (and can lose my vision permanently if I don't lose a LOT of weight soon and to keep it off). I've asked my surgeon to write another letter for the appeal as well showing his support.

My insurance is denying me because they are saying I need to have had a MINIMUM of BMI of 40 for past 5 years but my Summary Plan Description does not state those specific wording... even my 1st level denial letter had quoted wording that is NOWHERE in my Summary Plan Description. When I called to ask where this was found insurance kept saying just do 2nd level appeal..... I've reached out to corporate office for consumer affairs for the insurance company for them to look into this as I've had clerical errors from them from the 1st denial letter that were never corrected. I also have a 3rd party that my employer uses to act as "advocate" for me who has reached back out to my employer to find their specific definition they are using for "morbid obesity".

Denial reason- no BMI of 40+ for past 5 years

Summary Plan Description states - I need a physician to diagnosis me with morbid obesity for past 5 years

My HR Benefits Manager states they use industry standard and never gave me a direct answer. Insurance company never gave me a direct answer but by the denial letter and their consumer affairs representative they are stating it is BMI of 40+ and that is standard. Odd as the insurance company has their own policy for bariatric surgery that states morbid obesity is BMI 40+ OR 35+ with at least 1 co-morbidity (which I have) that they use for their fully funded clients (my employer is self-funded so it's really the employer's definition I have to go by). That is my fight right now. I provided tons of "industry standard" that is even found WITHIN the insurance company's own policy stating "morbid obesity" is 40+ OR 35+ 1 co-morbidity.... along with how several of the other big name insurance companies are using for "industry standard". I honestly feel like I can win this as this is the ONLY reason they are denying me.... I had a BMI of 38 and 39 for past 4 years and 40 this year (although in 2013... I'll be 40 again haha! So I need to get re-weighed and submit another 40 number now).

Yes you can win. Keep fighting and keep your head up!

Good luck.

[banditchic 83]

Approved. Surgery Date: 01/07/2013. Thanks lord and all of you for your good vibes and support.

Congrats!!!! I am very happy for you!!!! YEA

[Jen35 283]

Update - the surgeon's office just called to verify all my info before submitting it to the insurance. WTH?? My last appointment was 12/6 with the plan that it could take most of December for the insurance to approve meaning a January surgery date. I called on 12/18 and the coordinator told me it was submitted 12/17. I was upset about that because they could have submitted sooner. Come to find out, the letter was DATED 12/17 but hadn't been sent yet. So they are submitting today. I understand that they were closed a few days for the holiday and they're busy, etc. BUT it took them almost a whole month to submit. So now I may not know anything until mid to late January. And if they deny then it just pushes the dage out even further. It just screws up my whole plan....

[DreamsOfSkinny 53]

Approved. Surgery Date: 01/07/2013. Thanks lord and all of you for your good vibes and support.

Yay for you!! Exciting!!