Insurance Company Denied surgery
beckybernardo
Posts: 93 Member
I am so upset that after all this time and all I have went through that the insurance company denied my request for surgery. Their reason is because they said that I have not been on a doctors supervised diet for 6 months, paper work stated that it was only 4 months. I started seeing the doctor for this weight loss plan in March and have been there every month since. I have not shown that I have had a bmi of over 35 for at least two years, I have only had a mental health visit in April and May and they need to be done 3 months prior to request. This has made me soo mad. I have followed everything they have wanted me to do and still deny me. I don't know how much longer I have to wait to reaply. I really think that the insurance specialist has really messed up my paperwork, since she has lied to me through this whole process. Is there anyone on here who is from Minnesota that has dealt with Blue cross blue shield? what is the process if anyone else has been denied? Thanks
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WOW...... I have BCBS in CT . My doc's office has a "sheet" for each insurance company and what needs to be completed when to ensure no slips up with approval. In fact my NUT called me back to reschedule one of my appts because I had them too close together. You may have commented in the past but I do not recall, are you planning your surgery thru an approved Bariatric Surgical Center or just through a doc that does not do this exclusively? If you are working thru a BSC, then shame on them for not knowing what your particular insurance required.
I would call your insurance company and discuss the process and be sure YOU understand what is required when and what YOU can do to have them reconsider their denial. YOU must be your own advocate here. Don't give up on this.0 -
I checked into this hospital and they really seem to have it all together and had went to all their seminars back in march and april. All I had to do was the 6 month doctor supervised diet. This doctor has a bariataric clinic and you have to meet with a nutritionist, mental health doctor, physcial therapist. I have to meet with them all once a month, except for the mental health physician, but I meet with another mental health physican regualrly for my medications. I belive that the doctors office had replace the insurance specialist since my original meeting with them and I think she is the one who has messed things up. Now I can't seem to get ahold of her and of course I'm on hold forever with the inusrance company.0
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when the world whispers "give up" hope whispers try it one more time, hold fast, I know its dissapointing, but try again, they will approve you, good luck my friend!!0
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Thanks Mary, I have been so discourgage about this whole thing lately. I have almost given up the whole weight loss all together.0
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DON'T give up!!!!! I have United Health care...they called me and said I needed the 6 consecutive month diet plan too...I went to my PCP he had not documented all my visits that we talked about weight loss and surgery etc...I gave up but didn't stop the process with the ins. co. Last Monday I received a call from ins. saying "congratulations you are approved for surgery" WHAT?? I have NO clue how it got approved without the 6 month diet plan, since they said it was required...but I didn't ask questions...my surgery is scheduled for Nov. 5th....Do you have high blood pressure, diabetes, sleep apnea etc??? I have all three of them and my bmi is (or was) 46.8 so maybe they looked more at that and said OK..I really don't know..but what ever YOU do DO NOT give up...call them talk to them...0
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Mandy brings up a great point, can your PCP provide documentation of your weight history to establish what your BMI has been and provide a letter supporting an approval? One other thought, can you bypass the insurance coordinator at your surg center and "complain gently" about how she handled this and see what they can do? Don't give up on contacting the insurance company, maybe go on their website and see if you can do a live "chat" with them on line. Most of all DON"T GIVE UP !!!!0
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I dont' have high blood pressure, but have sleep problems and acid reflux probems. My bmi was I think, 45 or 46 when I started out, but I have lost 50 since march, so it has dropped. I never went to the doctor in the past for some of the problems because I didn't have insurance. But since starting this, I have been treated for my stomach ulcers, acid reflux, and sleep problems. I am still waiting for the insurance specialist to call me back, but I will complain to her and anyone who will listen because this has just added more stress that I didn't need.0
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stay strong and don't give up. my doctors office said if it gets denied, ALWAYS appeal. Keep the faith, if the climb to the top of a mountain was easy. The view would not be half as good. It will be worth it in the end.0
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Thanks all. I am getting up in the morning and start my calls again. If the doctors office insurance specialist does not call me back tomorrow, I am complaining to someone, I don't know who, but I am going to make a big stink about it and possibly check out the other hospital, but I don't think that it is as good as this one. Thanks for the support, I need it to keep me motivated to do this and not give up. I;ll keep you posted0
