Insurance Appeals

DeLarla · April 7, 2005

I found out some info for anyone that self-paid and wants to appeal their insurance. Before you can appeal, you have to actually file a claim. You have one year from the date of your surgery to file the initial claim. If you haven't decided whether you want to fight your insurance (since it's after the fact and you've already paid) at least do the first step of filing a claim before your one year expires in case you change your mind some day. Once you file the first claim, then you've bought time for the actual appeal.

You'll need a claim form with the "Universal Procedure Code." Send the claim form to your insurance with copies of your medical records and billing. They need records from 1) Surgeon 2) Facility 3) Anesthesiologist. Along with that you need to send your medical history of weight-related problems, diet journals and histories, etc. I'm not sure where to get this form, but any band surgeon should be able to provide the form along with the procedure code.

I'm in the process of filing a claim, which will most likely get denied. Once it gets denied I'll start the appeal process. I doubt I'll win this battle, but I think we should all appeal our insurance companies. If they get enough appeals, they might see the need to pay for this procedure instead of constantly battling the insureds.

I don't have my records from Mexico, and I'm not sure if my surgeon will even release them. However, I'm sending the claim in incomplete. At least I'll get the claim filed before it's too late... my one year Bandiversary is less than a month away, so I'm not wasting any more time.

Zoe · April 7, 2005

This is a great suggestion, DeLarla. I'm going to follow up with my insurance company to see if there's any chance of getting at least some of the surgery paid for.

Alexandra · April 8, 2005

Lisa, most insurers have a blanket exclusion against medical services provided outside the United States which I think would be very hard to get around. But if people have any followup care done here in the States, DEFINITELY file claims!! Keep all your receipts and medical records and go to town. Good luck and we're all rootin' for you!!