Denied!

I just got a call from my surgeon's office saying that my insurance denied me because my PCP didn't write the words that she recommends the surgery.  Nope she sure didn't.  Instead she wrote that it would benefit me and I would be a great candidate for the surgery.  So now she has to amend the previous letter to say that she recommends that I have surgery.  They also said that I had not had my NUT consult.  Again, they are absolutely correct, but the surgeon's office stated that I am scheduled for 5/2/16.  My patient advocate said that she usually doesn't appeal, that it's up to the patient, but in my case, she is going to because they are being too picky.  So I am not worried, just a little disgusted because I felt like they had jumped the gun by sending everything before I am finished with all of the pre op requirements.  Anyway, I have another wait.  That just gives me more time to dot my I's and cross my T's.

Sorry you didn't get approved.

Here's hoping that once you have everything required, you will be approved without delay.  Good luck

Thank you Kat.  This just gives me more time to shop!

That's so frustrating! I hope you get approved one everything is resubmitted!

I am very sorry this happened to you.   The fact they don't do appeals, but will do one for you is good.   I would suggest that you tell them to fax the appeal, not mail it in.  That can take longer.   Usually, they will do this, but just be sure they are going to fax it and they should get a response within 24 hours if not sooner. 

Good luck!  

They faxed or e sent the original, so I would imagine they will do the same.  They told me to sign the form giving approval for them to talk to the insurance on my behalf. You bet I will sign it!

Oh no! That's awful. I'm so sorry, but it sounds like you're handling it just fine. You're getting ready and you have a great attitude, you can do this!

Hope appeal process goes well. Fingers crossed!

Having been denied twice for bogus reasons I just want to say, don't give up... It's often the case that they deny like this but the good news is they stated plainly what you needed to resubmit and it's not terrible like , losing 10 % of your body weight or more 6 month diets or anything like that. It sounds as if you'll be approved after the office corrects this .... However IF you get denied again PLEASE know that it is your right to call your insurance company and say "I was to file a grievance and get an external review" do not give up , to many people do and that's what they hope you'll do !!

I was also denied for bogus reasons, but they gave in on appeal. Keep after them!!