Denied an Frustrated!!

[myturn0421 0]

I called my insurance this morning to check the status on my file, and they told me a denial letter was sent out this morning. They said it was denied because my 6 month supervised diet was not consecutive. WTH?!?! I KNOW it was. I had doctor office visits along with 1 year of Weight Watchers, which I was told would work as my six months alone. They said I only submitted May 07, June 07, August 07 and December 07. Now I can't get the insurance person to call me back so I can argue, and the lady at the surgeons office(who submitted everything) won't call me back either. I have everything, I kept copies - and I;'m not missing anything!:wink2:

[mtanna 0]

I'm waiting on approval from my insurance company AND I'm in Tyler TX also.

My paperwork was submitted 5/5 but I can't get anymore on the status except pending :wink2:.

You'll have to re-submit ASAP. I had another friend here who was denied but resubmitted and was approved in 3 days.

[Froggi 4]

When I do finish my 6 month diet my doc's office said they would fax all my stuff to the insurance and the insurance would fax my approval letter back within a few hours or a day. Why does everyone elses take so long? I can't wait until october.

[TexGal 0]

I understand your whole frustration with this process. After I went to my siminar I was told that my insurance would cover my surgery if I did a 6-month diet. So I went every month to Houston and did my classes, kept up with my menus, everything they wanted me to do. After I got done, I went to see the surgeon and they told me that I have a clause in my insurance that would not cover the surgery, and I would have to self-pay. So all of the work was for nothing. Turns out the guy did tell me wrong from the beginning and now they want me to pay for the diet done at the hospital, even though I did it because they told me I was covered. Now I am a self-pay and waiting on my surgery date. Just keep trying and appeal every chance you get and in the end when you have your surgery it will all be worth it. Good luck to you.

[myturn0421 0]

mtanna - who is your surgeon???

I'm using Charles Beall MD, he did my DH surgery last May.

Froggi - I wish I knew why it took so long. My file was at insurance for 2 weeks, and when I called to check on it the first time - they couldn't find it. My surgeons office had to re-fax everything. Now inurance has had my file for over three weeks.

[mtanna 0]

Hey MyTurn....

I'm going to Dallas to have mine done. Dr. Benavides with LapBand Solutions. I'm pretty much a chicken poop when it comes to surgery since this will be my first since my tonsils were taken out when I was 5 years old. I wanted someone with a LOT of experience.... However, I will be honest and say I've heard a lot of good things about the drs (all over) doing these procedures.

Do you have Cigna??

[myturn0421 0]

No, I have FiserV through Mother Frances Hospital. I spoke to them yesterday, and they told me I have to wait the rest of the six months. I guess I'm looking at late August, early September. Pooh. At least it's happening, I just have to be patient. :thumbdown:

[mtanna 0]

As weird as this sounds and I can't believe I'm saying.... The 6 months go by really, really, fast. Since you have most of it done, the rest will be a breeze.

The WAITING for approval is what's so nerve wracking.... Hang in there, don't get down!!

[mikki21 1]

I was denied in April and have been depressed since then. They said that I didn't have any viable co-morbidities, HELLO ISN'T OBESITY A DANG COMORBIDITY!!!!! I have joined weight watchers and I am hopeful that I can get this weight off, I am so tired of looking and feeling like I have been feeling. Best of luck to all of you out there, I hope you get what you all want!!!

[Daisalana 33]

Appeal, appeal, appeal!!

[myturn0421 0]

Thanks everyone. I'm working on it.

[kdlee 0]

I'm waiting on approval from my insurance company AND I'm in Tyler TX also.

My paperwork was submitted 5/5 but I can't get anymore on the status except pending :thumbup:.

You'll have to re-submit ASAP. I had another friend here who was denied but resubmitted and was approved in 3 days.

I'm having the same problem! Everything was submitted on 5/5 and is still pending in Nurse Review. I was told by the insurance company that it takes 15 business days!!!! I have Anthem BC/BS PPO.