Medicaid denied me

[Staceybug 0]

I researched a head of time. I know the requirements. Double checked with insurance and with surgeon. Finally completed the 6 month weigh ins as a monitored weight loss program with the primary care. Completed numerous tests and had a tentative surgery date scheduled then I got the call from my surgeons office saying they received a denial. Luckily the team is on top of things and called the insurance to ask why. They were told it was not deemed medically necessary. Even though they provided a letter stating it was. So I called my insurance and was told I was denied because I had no proof of excersize. I submitted the forms signed monthly by my dr with notes that included weights and calorie diet etc.... so I told my dr office that all I had was a fitness diary I kept, my dr advised me to do this in se months ago. So I'm wondering if anyone else has fad to go through anything like this and have they had better luck with the second submission? I'll be dropping off my journal at my surgeons office. They said they would fax copies and add another letter expressing how it is medically necessary. Fingers crossed...

[jacinthapittman 22]

Wow that sucks. Fingers crossed that everything works out. I will make sure to have my doctor document my exercise at every appointment now.

[JenH76 15]

I hope it goes through. You did a lot of hard work. Don't give up. Fight until they say yes!

[Sparkles21 35]

I have cigna but was originally denied. Have them resubmit and continue to go through all of the appeals. Don't give up. My surgery is tomorrow!

[QueenOfTheTamazons 634]

I had nearly the exact same issue. Was denied as not medically Ness. Follow found it was because I did the 6 months medically supervised diet with my Primary care physician and she did not specifically mention exercise in her chart notes.

I wrote a 3 page letter talking about my medical history, family history and how being over weight effected my current health and would effect my future health. I also got a letter from my pcp stating we discussed diet AND exercise at every visit. It took awhile but eventually I was approved.

Keep fighting the denials.

[vetla68 0]

100% Covered! [emoji2]

Sent from my SM-G900V using the BariatricPal App

[JenH76 15]

I researched a head of time. I know the requirements. Double checked with insurance and with surgeon. Finally completed the 6 month weigh ins as a monitored weight loss program with the primary care. Completed numerous tests and had a tentative surgery date scheduled then I got the call from my surgeons office saying they received a denial. Luckily the team is on top of things and called the insurance to ask why. They were told it was not deemed medically necessary. Even though they provided a letter stating it was. So I called my insurance and was told I was denied because I had no proof of excersize. I submitted the forms signed monthly by my dr with notes that included weights and calorie diet etc.... so I told my dr office that all I had was a fitness diary I kept, my dr advised me to do this in se months ago. So I'm wondering if anyone else has fad to go through anything like this and have they had better luck with the second submission? I'll be dropping off my journal at my surgeons office. They said they would fax copies and add another letter expressing how it is medically necessary. Fingers crossed...

Did you finally get approved??

[WitchySar 244]

That's strange, I have Medicaid and didn't have to submit anything about exercise at all. I was denied initially though because they didn't like my primary's note. It was too comprehensive apparently. She made it shorter and was approved the next day. Insurance will do anything they can to find reasons to deny because then they don't have to pay. Don't give up!

[Seahawks Fan 771]

SURPRISE SURPRISE!! I was waiting for a surgery date and today I get a phone call saying I have to do 12 physical therapy visits. I specifically asked if there was anything else I would have to do months ago and the answer was no after finishing everything I was told I had to finish they come up with this. My insurance is Molina and I'm on Medicaid. This makes me want to puke! Are there any other surprises I should be prepared for?

[WitchySar 244]

Physical therapy? That's the first time I've heard of that requirement.

[OutsideMatchInside 10,166]

Even though Medicaid is a Federal program, it is administered by states and they can have different rules.

Good luck.

[chynadoll619 247]

Approved threw medicaid first time no problems, I did my own weekly and exercise chart .. that was turned in with my file.. maybe that helped.

[Seahawks Fan 771]

3 hours ago, WitchySar said:

Physical therapy? That's the first time I've heard of that requirement.

Surprise again! Today I got another call & my surgery is scheduled for May 30.

[Seahawks Fan 771]

Got another call today & I was scheduled for surgery May 30.