insurance denial!

[sbake11 30]

So insurance denied my surgery saying its not a covered benefit! When it is.. ugh.. well let the appealing begin! Such bull.

[Guest]

What insurance company do you have?

[Cody's mom 247]

Mexico is always an option, just a thought, I'm going next month!

[sbake11 30]

I have tricare and I'm not going to Mexico lol I cant afford all that. Its being appealed. It should go through!

[Debbie3sons 1,936]

TRY & get any referrals from any Doctor's that will state it is necessary, maybe it will help with the insurance & appeal.

[shantra 73]

I don't know the details of your case but I know when I called my insurance company it depended upon the contract between my employer and them. My employers had it set that bariatric surgery is a covered benefit.. but he told me that a few other people had called and for most of them it was not in their contract so it wasn't covered. So it wasn't the insurance company denying, it was the employer. I don't know if that is true in your case.. but it truly sucks and I hope you find someone to help you.

[sbake11 30]

I have people takingg care of it. It isnt the employer. Tricare is military and I called before I even got started and they told me its for sure covered and if I met all criteria I'd be able to get approved.

[terrydumont46 1,954]

if its covered than a letter to your state's insurance commissioner might be of help. insurance companies hate when the commissioner gets involved. I had a surgery denied years ago with my insurance saying it was pre existing. I wrote a simple letter to the commissioner and within a week the surgery was approved. good luck on your appeals don't give up..

[Bring It On 55]

I have people takingg care of it. It isnt the employer. Tricare is military and I called before I even got started and they told me its for sure covered and if I met all criteria I'd be able to get approved.

Hello! I am Tricare North in Kentucky. My packet was sent to Tricare for approval 11 days ago. I got a call from my WL clinic today and they wanted a "pulmonary clearance". I have never had any pulmonary problems in my entire life, so I thought this a little strange. Just had to call my PCP and have a letter sent to the WL clinic that gives clearance. They in turn fax it to Tricare. I met the co-morbidity with Diabetes. I had not tried "Weight Watchers" or anything like that, so my doctor sent a letter of medical necessity to Tricare that went with my packet. I guess that was sufficient since all they asked for was the pulmonary clearance. Hopefully, I will hear from them sometime next week. I was told that they generally take 21 of the 30 days requirement for approval. Hope this helps!!

[sbake11 30]

Ty. Im trying really hard not to get discouraged. Ive had my mind set on it for a long time. If all else fails I have medicade so I have another shot. Ill just have to do 3 more apts with the dietician. Im praying it happens.. its getting me super depressed.

[sbake11 30]

if its covered than a letter to your state's insurance commissioner might be of help. insurance companies hate when the commissioner gets involved. I had a surgery denied years ago with my insurance saying it was pre existing. I wrote a simple letter to the commissioner and within a week the surgery was approved. good luck on your appeals don't give up..

Thanks how do I go about doing that do you know?