Denied insurance. We are crushed!

[jjinWA 511]

Have so much emotion right now! I am excited that I go in for surgery on the 17th of June.. Yes nervous too. My insurance has approved the procedure. But more importantly I am so very sad that my daughter received a denial letter today stating her insurance will not cover the sleeve surgery. I cannot express how disappointed we are at this moment. We started this process with hopes of going through this journey together. Ultimately, the last and final option for her is to self pay and head to Mexico. I know there are good surgeons there, but we really wanted to stay closer to home in case there would be any complications and of course there are worries of how any complications would be paid for since this will now be seen as elective surgery. Well, no choice about that now. We must just dry our tears and move on to the next step. I know many of you on this site have pursued the self pay route in Mexico and I have followed those threads closely. Anything you can add here will help me bring all this data together and help us make our final decision on the dr/hospital. To summarize...

1. Why did you select your surgeon specifically when there are so many to choose from?

2. What was your experience with the coordinator and customer service in setting up your surgery. Did they pick you up in the US and take you into Mexico and directly to the hospital/hotel?

3. How long did you stay in the hospital and in Mexico

4. What steps did your dr do to check for leaks?

5. How was the followup after surgery?

I know I am asking a lot from all of you who have had the surgery in Mexico, and cannot tell you how much I appreciate your feedback. Personal recommendations carry much more weight then does a flashy advertisement or a well versed spin from a savvy coordinator.

The information I have received on this site has been valuable in helping my daughter and I make the decision to have WLS. Now your input here will help me bring this journey to the other side to POST OP for both me and her! Thank you!

[Chelly 364]

Why don't you appeal the decision of the insurance company?

It can't hurt to try.

A lot safer here then in Mexico because you would have follow up after surgery.

This is just my opinion.

Good luck.

Edited June 14, 2014 by Chelly

[jenngottaloseit 89]

hi there,

I am so sorry to hear about her denial from the insurance. I went through that for ten years and I finally switched insurance and got on Obama care insurance. I know a lot of people are not happy with the changes that have been made but switching to this insurance is literally going to give me my life back. I hope things work out and will be sending positive thoughts your way.

[Sparklingbeauty53 202]

I met all the criteria and the first time I was denied. I appealed after doing more of their requirements and then I was accepted. Don't take no for an answer so easily! Find out the details of the appeal process and dot all your i's and cross all your t's and go for it again. Turn the crushed feelings into determination! Good luck to both of you!

[jjinWA 511]

We will certainly work thru the appeals process and fight for the reversal. It is sad that even though you and the dr agrees what is best for you and someone who does not even know you can make have the power to alter that decision. But yes, we will keep on trying to turn it around.

[AshleePage 65]

Hugs to you both. Wishing you well!

[Amyllf2 206]

Will the insurance approve a bypass? My insurance does not approve the sleeve at the same rate as the RNY bypass. They said the bypass is the "gold standard" with longer proven history.

[greensleeve 457]

What was their reason for the denial?

[cutiepieinchi 158]

Have so much emotion right now! I am excited that I go in for surgery on the 17th of June.. Yes nervous too. My insurance has approved the procedure. But more importantly I am so very sad that my daughter received a denial letter today stating her insurance will not cover the sleeve surgery. I cannot express how disappointed we are at this moment. We started this process with hopes of going through this journey together. Ultimately, the last and final option for her is to self pay and head to Mexico. I know there are good surgeons there, but we really wanted to stay closer to home in case there would be any complications and of course there are worries of how any complications would be paid for since this will now be seen as elective surgery. Well, no choice about that now. We must just dry our tears and move on to the next step. I know many of you on this site have pursued the self pay route in Mexico and I have followed those threads closely. Anything you can add here will help me bring all this data together and help us make our final decision on the dr/hospital. To summarize...

1. Why did you select your surgeon specifically when there are so many to choose from?

2. What was your experience with the coordinator and customer service in setting up your surgery. Did they pick you up in the US and take you into Mexico and directly to the hospital/hotel?

3. How long did you stay in the hospital and in Mexico

4. What steps did your dr do to check for leaks?

5. How was the followup after surgery?

I know I am asking a lot from all of you who have had the surgery in Mexico, and cannot tell you how much I appreciate your feedback. Personal recommendations carry much more weight then does a flashy advertisement or a well versed spin from a savvy coordinator.

The information I have received on this site has been valuable in helping my daughter and I make the decision to have WLS. Now your input here will help me bring this journey to the other side to POST OP for both me and her! Thank you!

You can do a peer to peer review. Don't give up without a fight!

[jjinWA 511]

We are waiting for the official letter in the mail. Yes, she is willing to do RNY if necessary but at this point we have to wait to find out the details for the denial. Yes, we will fight to reverse the decision, but must consider other options if the final answer is no. We shall see. Thanks to everyone for your supporting words and advice.

[jjinWA 511]

So we received the final word from facilitator and from ins. Seems my daughter at 5'4" has to have proof of BMI over 40 for past two years..... 2013 and 2012. She was only 38 BMI in June of 2012 so they denied her. She was 40.1 in 2013 and 41 in 2014. Whatever... No comorbities documented. Her bad back, swollen ankles, painful knee are not something that was adequately documented by dr even though all were mentioned in the dr chart notes in 2013. Soooo we go to the last and final option - surgery in Mexico. Right now I have researched Illan and Aceves and have info being sent to us from both offices. I expect she should be able to do this by August. I should be well enough and on my road to recovery from my own sleeve surgery (tomorrow) by then to travel with her. We WILL get through this and will eventually look back on this as only a glitch in the journey!

[eversum 12]

I went through the same thing, my daughter and I started our journey in 2012 knowing that we both wanted the sleeve after doing all out research , after out 6 month program we were told we could only get the band. I knew this would not work for me and there were too many issues but my daughter decided to go for it, I was sad that we didn't take this journey together . She lost about 40 pounds but had so many complications .jan 2014 I was told I could have the sleeve just go through the 6 month program again and now my date is June 27, my daughter is now planning on having the band removed and going for the sleeve in dec. care first changed it's policies ..it's been 2 years since I first started but it's finally here... So even through you can not take this journey together , it will all work out.. Good luck

[jjinWA 511]

Thanks for the support. I just returned last night from having my surgery. My daughter is scheduled for surgery on the 19th of August in Mexico. I hope to be well enough to go with her. I have documented all the meds. Etc as I went through the surgery and have a questionnaire ready for them to complete. I want to know antibiotics, blood thinners, nausea and pain meds, etc will be used. How they test for leaks and if they fun lab tests before she goes home to ensure no bacteria infection has set in. I will be able to use my experiences to follow along with her surgery. That is the est we can do at this point. Wish she could have it here, but that is. To going to happen. :-(

[tigerlily14 35]

Wish you both the best of luck

[KathyLynn160 27]

Did your daughter ever get her surgery done in Mexico? I was told by my PCP that I didn't meet all the requirements for insurance due to the documents for past two years. I'm considering going the mexico route as well...