Why do people get denied by insurance ?

[FatMamaw 7]

If your policy states that it covers weight loss. In my case the VS, and your bmi has to be 40, or have two problems such as high blood pressure, or diabetic. What reason would they have for denying it. Also it requires one hour with nutrition one hour psych. Which I have done. I am so nervous, and just wondering what reasons are given for denial. Any responses will be appreciated. Oh... I do not have anything medically wrong except the 40 bmi

[Michelle1977 27]

From my limited experiences (I'm still pre-op), the only time I've seen it be denied is if one of the following happened: 1) Insurance doesn't cover this type of insurance, 2) BMI < 40 with no comorbities, 3) required diet (if one is required) hasn't been done (some plans require 6 months of a supervised diet), 4) some plans require so many years of being obese, 5) psych eval failed (this is purely up to the person doing the psych eval....though from what I've seen those who failed had to attend to a certain number of therapy sessions before the therapist said they would pass the psych eval).

I'm sure there are others that I'm missing. BUT if you have done all of those you will probably get approved by insurance.

[luckylady131 51]

My insurance (Aetna) doesn't cover bariatric surgeries at all, so I knew I would be denied.

The insurance I had before (also Aetna - just a different policy with a different company) covered bariatric surgeries. You had to have a BMI of 40+. Or you could have a BMI of 35 WITH 2 co-morbidities (high blood pressure, high cholesterol, etc). You had to have your weight and comorbidities documented and diagnosed for 2+ years. You had to show that other weight loss strategies (weight watchers, exercise, etc) didn't work - and have proof of this (sign in sheets, payment plans, etc). You had to follow their 6 month regimen of psych consults/nutrition consults/exercise program/doctor visits/diet plan. It was a huge PITA. It cost me more money to be a cash patient, but it was a huge weight off my shoulders (hahaha) not to have to deal with the insurance company!

My only thing was my current insurance company does cover any complications that may arise during a bariatric procedure. So when my hiatal hernia was discovered during surgery - my insurance covered that part of the surgery. When I had to stay an extra day because I threw up constantly the day of surgery and I wasn't keeping any Fluid down - insurance paid for my additional (3rd night) stay in the hospital. I just made sure that my bariatric surgeon was in-network.

[FatMamaw 7]

Well I meet all the requirements so says the insurance rep from the docs office . I got my fingers crossed!

[JennyBeth 127]

Every insurance company is different with what their expectations are. If they feel you have not met those requirements then you get denied. Some insurance companies make it harder than others to get approved.

[FatMamaw 7]

If your policy states that it covers weight loss. In my case the VS' date=' and your bmi has to be 40, or have two problems such as high blood pressure, or diabetic. What reason would they have for denying it. Also it requires one hour with nutrition one hour psych. Which I have done. I am so nervous, and just wondering what reasons are given for denial. Any responses will be appreciated. Oh... I do not have anything medically wrong except the 40 bmi[/quote']

I just wondered if u have met what the requirements are on their website. Do they come up with other reasons not listed in your policy to deny you.

[SweetnCurvy 112]

I just wondered if u have met what the requirements are on their website. Do they come up with other reasons not listed in your policy to deny you.

From my experience, no. If u follow all the instructions from ur surgeon's office, you should be ok. Good luck!

[WillowsAngel_32513 70]

Well it really depends on your insurance company and which plan you have