Application denial

[RosePollard 12]

I have done my research, talked with my insurance, started monthly appointments with my PC doctor, and applied for the sleeve at OSU Wexner. I received a message from OSU stating my application was denied due to only having one comorbidity. I called my insurance back, and they assured me that I only needed one co-morbidity for coverage. In addition, I have another condition (NAFLD) that I don’t take meds for, and thus it wasn’t listed on my application (the application doesn’t ask for diagnoses, just medications). I am sure that my denial was an oversight, but now I am starting to worry. Has anyone else had this kind of problem?

[Sigi42 42]

Were you denied by the insurance company or the bariatric program? It **seems** like the insurance was on board--is OSU not an approved provider? Are they considered out of network? If OSU denied it, you might need to find a new program, as they could have more stringent guidelines than your insurance. University centers can be very strict because they usually have targeted populations that they want to recruit for research purposes, tied to their grant funding.

My advice is to call both your insurance and OSU, find out exactly where the hiccup was, and then appeal if appropriate...or find ask your doctor to refer you somewhere else.

Good luck!

[RosePollard 12]

Thank you for your reply. OSU and both doctors are in network. I honestly think it is an error. If not, I will definitely be looking at another provider. I didn’t even think about the research aspect of application approvals/denials. I have been calling OSU, but their return call rate leaves much to be desired.

[Sigi42 42]

Thank you for your reply. OSU and both doctors are in network. I honestly think it is an error. If not, I will definitely be looking at another provider. I didn’t even think about the research aspect of application approvals/denials. I have been calling OSU, but their return call rate leaves much to be desired.

Yeah, I noticed it when I was comparing the USC and UCLA (both insurance approved). I met the criteria for one, but not the other. Of course, then my doctor was like, Nope. Not in our network! You're going somewhere completely different!

I feel like I wasted a lot of my time [emoji23] [emoji23]

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[RosePollard 12]

I just talked to the clerk, who informed me that it did not look like they even contacted my insurance. They just denied it based on the assumption that I didn’t have 2 comorbidities (when I do) and that the insurance required 2 (they only require 1). They are in network as well. The receptionist said that the application has not been fully denied yet, so I am holding out hope that it will still happen. I hate that you went through this too. It is very frustrating!

[Sigi42 42]

That is just...laziness and unprofessional!! Ugh!

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[ProudGrammy 8,322]

17 hours ago, RosePollard said:

application has not been denied yet

@RosePollard

hey bud

sorry you are "jumping through" the hoops of insurance. continue to stay in touch with insurance

et al - when "they" tell you nay or yea - (hopefully yea) have them send you a letter, so no misunderstanding -if they do so nay - you should/must appeal!!

fingers & toes crossed☺️

good luck

kathy

[RosePollard 12]

Well...it turns out that OSU is still denying my application. Even though their website clearly states that they consider NAFLD and hypertension as comorbidity conditions, I was still denied. So, I found another provider in my network. My insurance has been awesome with helping me find providers, so I am fortunate. I hope the next one works out better than OSU.

[Sigi42 42]

Well...it turns out that OSU is still denying my application. Even though their website clearly states that they consider NAFLD and hypertension as comorbidity conditions, I was still denied. So, I found another provider in my network. My insurance has been awesome with helping me find providers, so I am fortunate. I hope the next one works out better than OSU.

The good news is that the insurance is cooperating--usially when we hear stories, it's about insurance drama. I bet it goes a lot more smoothly from here on out!

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