Denial

[MC BCBSil 3]

I was denied. Tomorrow is peer to peer review. It that is denied again I am going to appeal for the record to be official for the process of tracking these denials. I have been on this plan and expected my insurance to cover my recommended treatments. I could hardly believe it was denied. Feel very violated and taken advantage of by the company I pay every month for coverage

[SomeBigGuy 109]

I'm sorry you're having to deal with this. I was denied by my insurance company for years, got a pre-approval in 2021, and then denied again after I started the program. I had to do months of song and dance to meet their requirements, and then they just dropped me. I appealed repeatedly, and they gave me some BS response like the governor of the state that my insurance is based in effectively declared all bariatric procedures as elective and unnecessary. I ended up having to save up and do some self-financing to have a self-paid procedure.

It was stressful in the planning phase, but I am happy with my decision. The surgery team was very helpful, and are staying in regular communication 5 weeks out from my surgery. It is like a smaller used car payment (not a new car price at least!) but it was manageable.

I had my Gastric Sleeve done in the US as I was unsure about going to Mexico. I can't speak to the specifics on the pricing, but MX seemed to be generally half the price or less than the US, but it can be a crapshoot for the level of care. Some in the US have some room to negotiate, but a lot are firm on pricing. Just do you research, take a break, and redo the research again to be sure if you go the self-pay route.

Hoping your insurance comes to their senses and assists you with this. While this isn't a cure-all or "easy mode" approach to weight loss by any means, it is a very useful tool that will help your overall health and quality of life!

[BlondePatriotInCDA 418]

I'm sorry to hear you we're denied. Just keep pushing them. It amazes me that insurance companies refuse to pay for bariatric surgeries and weight loss drugs BUT have no problem paying for a lifetime for the health consequences of being obese.

I know I'm going out on a ledge here for potential condemnation but..those same insurance companies will pay for gender reassignment surgeries AND reconstructive "cosmetic" surgeries for gender reassignment (that in the long run is cosmetic to align with how patient perceptions are - no different than skin removal mentally) but they won't pay for some just as necessary bariatric surgeries and skin removal surgeries! Both can be mentally debilitating!

I always thought perhaps a class action lawsuit forcing insurance companies to pay for these things is what's needed. No one elects to be obese and insurance companies treats obesity as "its your fault" you're obese so they won't pay.

I wish you luck, preserver and eventually you'll get it! Lastly, I'm told bariatric surgery is cheaper in some states if you have to pay yourself, so shop around and research research research making sure you have a good bariatric team! Also, make sure that if you do go out of state that they don't have a long travel restriction like mine did (90 days) first!

Good luck!

[MC BCBSil 3]

Shopping around. Agree about the discrimination and or selectiveness of what constitutes health procedures. The track records speak for themselves. Hopefully someone pays attention to outcomes. Results should matter. If you pay for insurance you should not be brined coverage for proven health related procedures ever. That is why it is called health insurance but I agree that they want to keep you sick. Maybe they should call it sick and dying insurance. So sad so backwards.

[MC BCBSil 3]

Peer to Peer BCBS also denied. Had appointment with primary care and she formulated letter in support with various reasons that stated I met all the criteria required after the peer to peer now waiting on appeal. I have hear that these tend not to go well. Looks like BCBS will avoid meeting their obligations to subscribers. I am so disappointed. I been forced to wait though out this process 1st 6 months of requirements by the Cleveland Clinic (6/4/2023 - November 29, 2023) to get Denied. Then for peer to peer (December 30, 2023) of which I have received nothing in writing about results. Just a email from Cleveland Clinic saying it was again denied. I let them know I wanted the Appeal that they submitted in January and now I will not have a result for another month 2/17/24. In the mean time still getting fatter went to annual appointment primary care 1/8/2023 and it is official BMI 41.2 with high blood pressure, joint issues and overall just not feeling well. OSU primary care wrote letter supporting me having procedure and yet BCBS still continues to make me wait. I was told decision will be available on a Saturday 2/17/2023 and that too seems a little off to me to make decision available on a Saturday. In mean time I am held hostage to this appeal process. I was told by BCBS I could yet appeal again to another outside agency if I am unhappy with their findings. This sucks and this should not be the health care insurance companies treat not just their insured clients but the hospital that support their plans. This is so out of wack. If somone qualifies for treatment by their provider (my doctors) and through the terms of my health care policy (BCBS) I should not have to go through this mountain of red tape and still yet possible be denied the care in which I pay for every month. This sucks.