Denied!!!!!!!!!

I rec'd my first denial from the insurance. Anyone have any input on an appeal? I am not quitting yet!!

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Lucky for me I didn't personally experience any problems but I've read a LOT on here about people having to really fight for the coverage they have! So until someone w/that experience posts, I can say you need to find out WHY they denied you and then start countering that.
Some companies are notorious for being knee-jerk about denying, hoping that the patient will just give up. Sad but true!

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PCM 7/3/08 Seminar 7/10/08
Upper Gi, Psych,Nutrition, Surgeon 7/25
Tricare Approved 7/31
1st surgery 8/11 thick liver no band
Banded 8/29/08!!! BY:
Dr. Sonny Cavazos, Texas Bariatric

What kind of insurance do you have? Most of the time you can get it overturned if it is covered. Sometimes it is something small that is causing you to get denied.

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Humana (doesn't cover) and Tricare Insurance
Tricare denied! Appealed and reversed!
Surgery September 30th
First fill Nov 5th 1cc (total of 4 cc in band) Highest=233/preop=220/present=150

I recieved a denial also and I am wondering what my next step is...can anyone help me?

I have been denied also and i am wondering what my next step should be...can anyone help me who has been denied?

There's several things you can do. You can call for a more detailed reason, why you were denied. Sometimes they aren't specific enough why you were denied. I didn't get much information when I was denied. Basically they wanted MORE information. They said I didn't prove this is medically necessary for me to have this surgery. I contacted obesity law and hoped they could help me. I gave them a lot more information too. I am waiting for my appeal letter now.

Good luck. Your doctor's office may know how to help you best. My Dr.'s office wants nothing to do with the appeal process so I was lost. You best bet is to rethink what you submitted in the first place. Did you have meal plans, exercise logs, gym membership receipts, did your Dr. document your behavior changes and your weight. These are very important.

M

From what I heard that is an appeal process. But like other posters stated, yous hould look up all the specific reasons you were denied and fight them. Pull up your benefits and the criteria for surgery. Good LUck!

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This makes me worry. I see my dr tomorrow then they are putting everything in for approval, I don't know how long that takes but seeing people denied makes me worry now.

Keep us in touch, let us know how your appeal goes so we know what to do if needed as well.

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Teresa
230/227/135
Seminar 9/17 Phys 10/01
Nutrition 10/14 Psych 10/21
Consult 11/5 Sent to insurance 11/18
Denied 12/8 will appeal

APPEAL! I agree with RestlessMonkey, a lot of insurance companies automatically deny the first time through.

I was denied and I wrote 2 letters from me, 1 medical and 1 emotional aspect of obesity. Then I went to each of my doctors and asked for a letter of support. I got letters from my PCP, GYN, Gastrointerologist, podiatrist, and bariatric surgeon. Then submitted the entire package. BC/BS rep called me directly and said she never saw an appeal like that and they had decided to approve me.

If anyone would like samples of my 2 letters, I'm happy to share them. PM me your email address and I'll shoot them out to you.

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Suzanne

Banded 1/4/08
Dr. Brengman - Richmond, VA
Fill level = 7.1cc
Goal: 150 (doc's goal)
Ideal weight: 135

I was denied on the first two rounds. My surgeon was the one to contact UHC to see just what they needed. I involved my PCP and had him submit a letter with the information UHC required (I actually wrote the letter as a sample for him--he ended up using it verbatim). I was still denied on appeal. I finally got my corporate advocates people involved and they worked with UHC. I was approved last week and will have surgery on November 19th. It's important to be persistent, but I found that the doctor's office will get more information than they will give to the patient. I have a sample letter from the PCP if you want it--PM me with your email and I'll send it to you. Good luck and don't give up!!!

I was denied 2 times before approval! I am not a pushy person but, I decided that I really wanted this and I called my insurance weekly until I was approved. I kept getting excuses from the insurance co! I really think most people do not push them and they do give up! Don't give up on this if you really want it!!!!! Its worth the fight! I wish you the best!

I was denied the first time. My surgeon talked to the insurance company and found out that my sleep study was missing from the packet submitted
to the insurance company. It showed I have sleep apnea. So the surgeons office resubmitted it and I was approved. So, the best thing you can do is find out why they denied and if you think they are wrong, check and make sure your paperwork was complete. Good luck to you all.
Maggis

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Pre-op wgt. 258
Goal wgt. 150

Surgery 10/29/08

Pre-op 8lbs lost=250
01/01/09---------233lbs.