insurance denial

hopeful1 · August 10, 2004

New Hope,

I just received my first denial letter today and I think (hope) what it's saying is the insurance doesn't have all my information and tests. My insurance required a psych eval, nutritionist visit, and some other tests - thyroid, glucose. I had heard they required documentation of 6 months of dieting under a doctor's supervision. I had proof of maybe 3 or 4 mos. at WW. Excess weight is 120 lbs., BMI is 42.5(?). I do have (17 yrs.) hypothyroidism and take synthroid and hope that's not the problem.

But to get to the point - why did it take you eight months to get approved?

P. S. Our insurance just approved a co-worker for gastric bypass with no problems. I do think we are self-insured but with Great-West.

New Hope · August 10, 2004

I have ins. through United Healthcare. I really don't know why it took 8 months. They sent the initial denial in 10/2003. I appealed it. Then 05/2004 my lap. dr. office called and said I'd been approved and when did I want to schedule the surgery. So the usual "hurry up and wait" routine, or in my case..."wait, now hurry up!"

That certainly is NOT the case for everyone! They all seem to have their own little protocol. I'll certainly hope that yours will be faster. In the meantime, look up Alexander's appeal letter on this forum. It is excellent!

Don't give up, just get determined!

Now's the time to start working on walking regularly, drinking tons of Water, and not drinking with meals. These are all great habits to get into whether someone is banded or not.

Alexandra · August 10, 2004

Hopefuol, what exactly does your insurance denial letter say? If it's just a matter of incomplete documentation, that's not a denial at all, it's just more red tape. Does it anywhere say that the procedure is not covered? Or is it just telling you it's not approved at this time? They are very different things; don't give up being hopeful!!!

hopeful1 · August 11, 2004

My letter does say "Denial" but then it goes on to explain that the insurance doesn't have certain things that they require. It doesn't say the surgery isn't covered. I guess that's why it was confusing.

I did call the surgeon's insurance gal today and haven't gotten an answer back yet. So I remain...

hopeful1:)

hopeful1 · August 11, 2004

Oh, and thank you Marie for reminding me of what I should be doing. I've had a hard time getting on that wagon. My doctor wanted me to lose 12 lbs. prior to surgery and I'm only about half way there.