Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Recommended Posts

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?????

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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!!

Share this post


Link to post
Share on other sites

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 :(

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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!

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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

Share this post


Link to post
Share on other sites

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!

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

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.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • cryoder22

      Day 1 of pre-op liquid diet (3 weeks) and I'm having a hard time already. I feel hungry and just want to eat. I got the protein and supplements recommend by my program and having a hard time getting 1 down. My doctor / nutritionist has me on the following:
      1 protein shake (bariatric advantage chocolate) with 8 oz of fat free milk 1 snack = 1 unjury protein shake (root beer) 1 protein shake (bariatric advantage orange cream) 1 snack = 1 unjury protein bar 1 protein shake (bariatric advantace orange cream or chocolate) 1 snack = 1 unjury protein soup (chicken) 3 servings of sugar free jello and popsicles throughout the day. 64 oz of water (I have flavor packets). Hot tea and coffee with splenda has been approved as well. Does anyone recommend anything for the next 3 weeks?
      · 1 reply
      1. NickelChip

        All I can tell you is that for me, it got easier after the first week. The hunger pains got less intense and I kind of got used to it and gave up torturing myself by thinking about food. But if you can, get anything tempting out of the house and avoid being around people who are eating. I sent my kids to my parents' house for two weeks so I wouldn't have to prepare meals I couldn't eat. After surgery, the hunger was totally gone.

    • buildabetteranna

      I have my final approval from my insurance, only thing holding up things is one last x-ray needed, which I have scheduled for the fourth of next month, which is my birthday.

      · 0 replies
      1. This update has no replies.
    • BetterLeah

      Woohoo! I have 7 more days till surgery, So far I am already down a total of 20lbs since I started this journey. 
      · 1 reply
      1. NeonRaven8919

        Well done! I'm 9 days away from surgery! Keep us updated!

    • Ladiva04

      Hello,
      I had my surgery on the 25th of June of this year. Starting off at 117 kilos.😒
      · 1 reply
      1. NeonRaven8919

        Congrats on the surgery!

    • Sandra Austin Tx

      I’m 6 days post op as of today. I had the gastric bypass 
      · 0 replies
      1. This update has no replies.
  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×