What do I do now?

[Thenewmrssmith 36]

I started this process in February. Everything is done. Surgery is next week. Today I was denied because my insurance doesn't cover bariatric surgery. Is there anything I can do?????

[DeniseM 238]

Have you called your insurance company to confirm this? I would definitely make a phone call and have them review your policy just to be certain. Do not take someone else's word for it.

[BloomingFaith 29]

How devastating!!! They didn't look into this beforehand?!?! Call your surgeon and see if he/she can write a letter of medical necessity?

[Thenewmrssmith 36]

They don't call my insurance company until they have all the papers. It's beyond a medical necessity at this point. If I don't have this surgery I will probably drop dead! In the long run it will only cost them more $$$ by me not being able to have this life saving procedure!!

[Thenewmrssmith 36]

Have you called your insurance company to confirm this? I would definitely make a phone call and have them review your policy just to be certain. Do not take someone else's word for it.

I called them this morning to find out if I was approved and that's when they told me

[jenlen 58]

I called them this morning to find out if I was approved and that's when they told me

Definitely file an appeal! They just did the same thing to my Dad who is the most 'medically necessary' person in the world. We got his primary doc to call them and they staid they did not "read the second page of his claim where all his comorbidities were listed". They just gave the go ahead nd he is now scheduled for 7/17.

Start the appeal ASAP! Sometimes they need to know you are dead serious before the finally give in.

If all else fails there are several options for the dreaded private pay, which is what I had to do. Please try not to let this get you too down (I know first hand how devastating that news is) and keep up the good fight. There are ways to make it happen although it is just so frustrating to be forced to jump through hoop after hoop when all you want is to reclaim you health and life back.

[Ms.AntiBand 2,984]

Does your insurance cover WLS? If it does then appeal and keep appealing. They want you to give up so they don't have to pay for it. They count on people not appealing. If it states in your policy that they don't cover WLS then they don't and there's no appealing that at all. That's a done deal

[Ms.AntiBand 2,984]

Oh, I just noticed you said they don't cover WLS. How this got past your drs office is strange. The admin should have thoroughly looked into your coverage when you came to them. Sorry you're not coverd and hope you can work a self pay surgery into your budget.

You also said everything is done? You mean tests and evals and that sort? Who paid for these? If the insurance did then be prepared to have to pay back.. Hopefully, it will slip past the billing, but dang..watch out. Good luck

[Ms.AntiBand 2,984]

My insurance doesn't cover WLS or ANYTHING related to it regardless of medical necessity. I clinically died twice and they did not cover my urgent care under medical necessity.. If its in any relationship to WLS they are not required to pay. If your insurance says they don't cover WLS then they don't.

Sorry to post so may times, but I just keep seeing more of what you posted.

[PGee 318]

Wow, that's odd......I went to an informational seminar. Even though I knew WLS was a covered benefit, the surgeon's office had to verify it with my insurance for themselves and verify the required steps to get approved. I wish I had helpful info for you.....good luck with this!

[janeeckman 4]

My office has an online educational informational section. Quesitons about my insurance was one of the sections. Before I even had my first appointment, I had my acceptance letter in hand. so sorry to hear this news. go fight it.

[clk 3,519]

Get onto the insurance forum and check around for other folks that have your insurance and see what they did and if they had any luck with an appeal.

I self paid. I'm Tricare; they do not cover the sleeve. I didn't want a band or bypass, so I went ahead and paid for my own surgery. Not a light decision but honestly? Paying for it myself probably made me the teeniest bit more determined to succeed.

Best of luck, sorry you're going through this.

~Cheri

[Nursebarbie 392]

First call and file an appeal. Ask your doctor to also file on your behalf. I have several friends who got approved on the 2nd or 3rd appeal. Squeaky wheels get the grease!

[jenlen 58]

First call and file an appeal. Ask your doctor to also file on your behalf. I have several friends who got approved on the 2nd or 3rd appeal. Squeaky wheels get the grease!

Couldn't be more true! Good advice.

[DayByDay 123]

I started this process in February. Everything is done. Surgery is next week. Today I was denied because my insurance doesn't cover bariatric surgery. Is there anything I can do?????

The main thing to ask your insurance company is if it has a specific exclusion in your policy that calls out WLS is not covered. If it does there isn't anything you can do. A million appeals won't work, they will not cover it. I know because my policy does not cover it no matter how sick your are. So I was self paid.