Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Recommended Posts

I called my insurance company IBC PPO back in August, they sent me a copy of the bariatric policy. BMI over 40, weight loss attemps, etc. This is for it to be covered under medically necessary. Is the what everyone else used or does everyone else have a bariatric rider?

The surgeons office said I was denied because I do not have coverage. I had to call the insurance company 4 times before I found someone who referred me back to the policy I was sent in August. I am so confused. I have been on the phone all day!

Curious if anyone else got the same run around. Fingers crossed I hear good news soon. Hoping I don't have to pay out of pocket.

Share this post


Link to post
Share on other sites

Document all conversations, who you talked to, their title, ask for the denial letter, etc. The person may have put down incorrect information about diagnosis, or incorrect coding on the submission.

First on your policy do you meet that criteria? Do you have documented failed attempts at weight loss - like Weight Watchers weigh-in logs, or your doctor visits whete you weighed in and talked about weight loss?

Can you take your policy with you to the surgeon's office and call your insurance from there? Keep pushing.

You either have coverage or not, but it sounds like you have coverage. Is it through work or ACA? What state are you in?

Hang in there?

Edited by Sosewsue61

Share this post


Link to post
Share on other sites

Yeah it's usually some kind of error on the forms

Share this post


Link to post
Share on other sites

That is the common coverage for bariatric surgery, having a BMI 40 or over or a BMI of 35 or over with two comorbidity factors. The surgery has to be medically necessary for them to cover it under insurance. They're not going to pay for someone who doesn't need it to have it.

Share this post


Link to post
Share on other sites

I called back on August 12th and the insurance company sent me a copy of a policy. According to that policy I met all the criteria. The past 5 months I have done all the requirements from the surgeon, cardiologist, sleep study, psych eval, endoscopy, and bloodwork. They submitted it to insurance, denied. From what the surgeons office found out is that my specific group # does not include that policy. On hold right now to file a members appeal. Not too hopeful. Seems like I will be stuck paying out of pocket.

Share this post


Link to post
Share on other sites

Insurance is still telling me I am covered if its deemed medically necessary. They said to have the surgeons office appeal. The surgeons office is telling me to do a members appeal. Ugh, so frustrating.

Share this post


Link to post
Share on other sites

What does your company HR say? Corporations can carry different coverages under the same company than another corporation.

Share this post


Link to post
Share on other sites

Its a small company, I am part of the HR department, lol. Our brokers aren't terribly helpful. I will reach out to them next if I get denied again.

Still waiting for an answer since it was resubmitted by my surgeons office. I am on the phone an hour every morning making sure it moves along. So frustrating.

Share this post


Link to post
Share on other sites

Denied again. Now I have to do a members appeal, 30-45 days. They are still saying I don't have coverage even though every time I call to talk to customer service they say I do.

Share this post


Link to post
Share on other sites

On 1/27/2020 at 9:18 AM, chrispat123 said:

Denied again. Now I have to do a members appeal, 30-45 days. They are still saying I don't have coverage even though every time I call to talk to customer service they say I do.

Hi, can you tell me what happened with this? I had the same thing happen with UHC in February. Last week I exhausted my final appeal and the bariatric center told me I'd have to go somewhere else, because they do not offer a self pay or financing option.😨

Share this post


Link to post
Share on other sites

I know it has been a while, but wondering about your outcome.

It was not clear to me whether you were told that (a) your insurance policy covers bariatric but you didn’t meet their medical necessity criteria OR (b) your insurance policy under your employer doesn’t cover bariatric procedures (some do not). “A” is workable while “B”is a dead end unfortunately. As you are in HR I realize you know the difference, I just could not personally figure out which situation you were in from the post. ☹️

Edited by AlwaysCruising

Share this post


Link to post
Share on other sites

It turned out my employers plan specifically excluded the surgery. When I called IBX to check if I had coverage, they said yes. So I wasted a lot of $ in copays and time for a procedure I was not covered for.

I appealed 3 times, lost each time.

Just switched to my husbands insurance. That starts in September. Fingers crossed I don't get screwed again!

Share this post


Link to post
Share on other sites

30 minutes ago, chrispat123 said:

It turned out my employers plan specifically excluded the surgery. When I called IBX to check if I had coverage, they said yes. So I wasted a lot of $ in copays and time for a procedure I was not covered for.

I appealed 3 times, lost each time.

Just switched to my husbands insurance. That starts in September. Fingers crossed I don't get screwed again!

Aww 😞 yes, in such cases denials won’t work (I wish they had also told you that). I am so sorry someone gave you bad info early on, it feels rotten to lose time and effort and $! Many policies will now cover it so I hope your husband’s does! And as long as you aren’t a year off from some of the screenings (e.g. the psychological evaluation) they will still be valid (except the 30 day ones like labs).

Edited by AlwaysCruising

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Bashbee91

      Hey guys new to the process looking forward to this new life. 
      · 0 replies
      1. This update has no replies.
    • Bugg

      Hi everyone! I’m brand new here. I just went through all my pre-op requirements per my insurance company and now everything has been submitted and I’m just waiting for final approval and my surgery date. I’ve been doing research, watching YouTube videos, TikTok’s, ect.. trying to prepare my mind and what to expect so I’ll be ready for the surgery. I was so sure and so set and so ready and excited. However, now that I’ve done everything & it’s almost here, I am sooooooo scared! I know why I want it bc I’ve tried everything and I just don’t feel like I can lose weight by myself. I’m tired of being overweight my entire life. I’m miserable, but I keep psyching myself out afraid of GERD bc I know how that can be and I don’t want to have to get a bypass after already gaining the courage to even get VSG. I’m scared of complications like I’mgoing to regret doing it and be depressed that I didn’t just be more disciplined and try again to lose the weight on my own even sitting here typing this knowing in my mind i just can’t and don’t possess the discipline. I’m also afraid I won’t be able to handle the restrictions of the sleeve. What do I eat? I don’t know how to eat healthy really and don’t enjoy healthy food. I don’t know how to do this! I feel so defeated!Someone tell me they felt anything similar to this or am I not ready? I thought I was. I am so tired of being sick and tired and so tired of myself and so tired of being stuck and stuck in this body and somebody different on the outside from what I feel inside. I just want to ball up and cry.
      · 0 replies
      1. This update has no replies.
    • buildabetteranna

      over 20 lbs down since4 the pre surgery diet and surgery on the 14th
      · 1 reply
      1. Selina333

        Yay!! Congrats. I know how good that feels. 🤩

    • Jenopolis

      Had a sleeve in 2017, lost over 100 pounds. Had a DS surgery this year (2025) for more sustainable weight loss. 🤞
      · 0 replies
      1. This update has no replies.
    • buildabetteranna

      The 14th was my day. I am home and recovery is going pretty smooth. They even let me walk out of the hospital. Picture of me in recovery curtesy of my boyfriend lol. 

      · 3 replies
      1. DaisyChainOz

        Glad it went well!! Wishing you a speedy recovery and wonderful success!! 🤗

      2. buildabetteranna

        Thank you ❤️

      3. Selina333

        Neat you have a pic of this day! I was sooo happy to get my surgery. It was well worth it! And I'm not even near my goal. I had surgery Dec. 2!

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×