Denied.

[magnificent2015 34]

I was denied by my insurance because it wasn't a part of my contract. I'm still going to attempt to appeal it, because physically I really need this surgery. The amount of daily pain I'm in is insane. Heaviest I've ever been. Has anyone appealed after denial & got an approval of it wasn't apart of your contract? Also, I'm looking into possibly self-paying my physician with a large sum down payment & financing the rest if possible. Or just going to Mexico with the 5k I had already saved towards possible reconstruction surgery I would need after my weight loss. Any advice or insight would be deeply appreciated!

[Bufflehead 6,358]

I don't want to be overly discouraging, but I will say I have never heard of anyone being approved if bariatric surgery is not covered by your insurance at all. The fact that you need the surgery seems to be irrelevant -- it is either in the contract, or it isn't. But appealing won't cost you anything so I say go for it, but keep working on those back up plans. Many people go to Mexico for their surgery and do fantastic. That was my back-up plan if my insurance denied me, I even had a surgeon picked out and felt very comfortable with the option. Good luck to you going forward!

[Sharon1964 2,530]

I have heard of a few people that have been successful, but ONLY because the insurance company misled them and told them they were covered for the surgery for a period of around six months or so before discovering the mistake (while they were still in the preop phase).

If the insurance company hasn't done anything like that, I would say it really isn't an avenue to put any hope into. Your "need" has nothing to do with it. Insurance is a business; it's not about healthcare.

[rgodfrey09 98]

As someone who works in the insurance industry, if it isn't covered by the plan you or your work purchased, it isn't covered. I can count on one hand the times we have extended coverage when it wasn't there and every single time was because we made a mistake and informed the person they would be covered only to later turn around and discover that we were wrong and misread the policy. Aside from that, I can't imagine it being overturned and if it was it would be a CEO decision. I don't want to be discouraging but the likelihood is slim to none. Bariatric Pal has a great program in Mexico that a TON of people have posted about having great success with. Good luck on your journey!

[magnificent2015 34]

Actually, I was denied because my insurance wants 12 consecutive months of nutrition visits. I don't know if it's worth appealing, but I will try. I've done numerous medically supervised diets over the last 3 years, maybe not all back to back but I've done them. My surgeon is actually trying to get our policy changed, since our insurance is through the actual hospital I would be having the surgery at. I'm in Rhode Island & apparently my insurance is following the guidelines that BCBS of California has put in place. I did read online that it is possible to get the denial overturned with an appeal.

[magnificent2015 34]

I didn't know it was because of the 12 consecutive months, until I received the letter in the mail, I must have understood when I called into the insurance & when she initially told me I was denied.

[rgodfrey09 98]

Ahhhh that makes more sense then! I had to do 12 months with mine, so if you do have to I can say it actually allowed me to really prepare my mind and body but I can appreciate the anxiousness to do it! Good luck!