Insurance denied me 1 week before surgery

[saltykisses 27]

Insurance denied me after going through all the appts, meeting criteria and even after Drs supposedly verified benefits.

I literally cried the whole day. I found some light at the end of the tunnel the following day. My friend told me about a Dr in same city who will do surgery if you have one of the two. 1) hiatal hernia or 2) need gallbladder removed. I have #1. Dr offers to do sleeve at same time as hiatal hernia repair, I just have to pay the $5k separately. Which i have opted to do. Supposedly my comorbidities are not severe even. Surgeon and insurance Dr had a peer to peer but nothing. I almost feel dupped by the surgeons office so they could bill my insurance for all the exams... they'd told me everything was good to go 🤔🤔 (could just be me frustrated).

In any case, I start new liquid diet tomorrow. Original surgery date was 12/19- new date is even sooner LOL 12/15

Anyone else been denied , and why? And which insurance?

[Sosewsue61 3,185]

You don't really give the exact reason for denial, or insurance criteria for coverage in your post. Elaborate please and what insurance - work provided, state provided, ACA, etc.

I am happy you lined up an alternative solution, just research the surgeon so you know what you are dealing with, also if there are complications from the vsg, your insurance may not cover that and you could have a huge out-of-pocket outlay afterwards. Just be informed. Good luck.

[saltykisses 27]

Hi there! Insurance told surgeon that my high blood pressure, high cholesterol and BMI were not enough. I have documented severe high blood pressure for over 10 years. My BMI is 34. Dr told me it would qualify with the other comorbidities so that's why I continued the process. I'm in Texas. I have AETNA. Good point, I will ask the new surgeon about complications!

[Sosewsue61 3,185]

I do read generally that bmi needs to be 35 w comorbidities on most policies, and high cholesterol was not considered one on mine. I wish you well on your surgery.

[Apple203 1,314]

6 hours ago, saltykisses said:

Hi there! Insurance told surgeon that my high blood pressure, high cholesterol and BMI were not enough. I have documented severe high blood pressure for over 10 years. My BMI is 34. Dr told me it would qualify with the other comorbidities so that's why I continued the process. I'm in Texas. I have AETNA. Good point, I will ask the new surgeon about complications!

Man, that is tough to hear. My surgeon was very specific about having a BMI of 35 when he submits to insurance at the end of the process. At the initial seminar, our first homework assignment was to get our insurance's bariatric policy in writing.

Good for you for finding a backup plan, but the out-of-pocket costs must be irritating.