INSURANCE DENIED FOUR DAYS BEFORE SURGERY !

[dlh16 22]

Who does this ? Who destroys a humans hopes and dreams after 6 months of preop, copays, expenses for tests, gas, time, ect.. ect.. I had 6 weeks of my work schedule removed that I now have to get back, I have inconvenience coming out of my ears for family, pets, all this money spent on shakes, $2500 cash copay made last week, and I'm so pissed I just don't know what to do !!! My eyes are so swollen from tears.. My insurance co. Stated I have controlled blood pressure and my bmi is only 37.5.. Now to be approved you need a bmi of 37 and only ONE OF THE FOLLOWING . high bp, diabetes, cholesterol. I'm just so lost, confused, sad, angry, depressed, and ooohhh so pissed !!! Do they not tell you BEFORE going through all the necessities ? Its not cheap !! I will be calling tomorrow to follow an appeal for sure !!!! I pray nobody goes through this. I shouted it to the world because I was so happy and now I'm just a huge, fat , unhealthy disappointment to everyone and myself !!!!

[kvoneye 210]

I'm so sorry you are going through this. I would have your dr help you appeal your case because they know more about your health then the insurance company. Please don't say that you're a huge, fat, disappointment to yourself and everyone else. KEEP your head up!

[citygirl1962 50]

Are these requirements in writing in your benefits booklet? If not, I'd file a complaint with the insurance department in your state, assuming you are in the US. Every state has an on-line complaint form.

[jlrandal 5]

Oh my! That stinks!! My doctor wouldn't even schedule surgery without approval.. Hopefully they can help you speak it and you can work it out.

[Dawn42smith 7]

It's not uncommon to have to appeal. Most times if you appeal they will come back with the ok. Also your doctor should not schedule surgery until after your insurance approval. Keep your head up and appeal!

[DangerMouse007 105]

Also your doctor should not schedule surgery until after your insurance approval.

Not sure about this part. My surgery was scheduled six months in advance...granted it was considered "tentative" but everything I had to do during that six month wait was geared toward that specific date. I think the only timing requirement came near the end of the six months where there needed to be a 14-21 day gap between my final check up in the sixth month and the surgery itself probably to let the insurance company have time to make their decision.

[MichelleInMexico 3]

Read between the lines...

Your HBP is controlled? Why? If it wasn't you'd be approved? Hummmmm..... Play their game. Appeal.

[mimic86 23]

I agree with Dawn42 smith, I heard that when people have to appeal it often goes through, it's just the insurance company putting you through hoops. I can MORE than understand your disappointment, just try to keep your head up, if you review the boards you will see you are not the only one out there that had to go through these obstacles and it worked out well for them as it will for you. Again I'm sorry you're going through this :-/

[Joymarie333 41]

Try a peer to peer

[otillie03103 123]

I work for an insurance company as a nurse care manager and sometimes it isn't hoops at all that they are putting you through. Sometimes the nurses that do the reviews get very little documentation from the doctors with the request and they don't have the appropriate information to make an informed decision. Please, communicate with the surgeon and as mentioned above, if the denial was very recent ask for a peer to peer reconsideration (your surgeon can call in and request to speak with a medical director at the insurance company directly if they offer it). Otherwise, you will have to go through the appeal process, have the surgeon send in anything and everything that they feel will help support the medical necessity of the procedure. I almost went below the BMI and had to maintain my weight for a couple of months to ensure I would get approved because I had no other comorbidities. If your surgeon knew the requirements and didn't communicate what you should do to ensure approval, then that is on you and the surgeon, not the insurance company. The insurance company is just following guidelines that have been in writing in your policy since you had the policy.