Insurance rejection and appeals

on 8/16/17 7:16 am

Has anyone had a first time rejection from your insurance company and then got approved on a appeal? My insurance does not cover bariatrics but my doctor is deeming my surgery medically necessary so she told me it would get approved. So frustrated right now. I have severe gerd and diverticulosis. 2 doctor referrals, ekg, upper GI, manoscopy all showing I have bad acid reflux. If anyone has gone through this any advice would be much appreciated!! I am trying to get my VSG revised to RNY

Virgie Tschirhart
on 8/17/17 10:41 pm - Midwest City, OK
RNY on 12/27/17

Which insurance do you have? I have BCBS Federal I live in Oklahoma. They paid for my LB in 2008 did not lose much weight maybe 17 lbs and developed a hiatal hernia which gave me acid reflux. I had a revision in 2009 the Sleeve lost 30 lbs. but still had a bad acid reflux and a hiatal hernia. I did not know the Sleeve was going to do that or I would have asked for the RNY instead. They denied my Sleeve revision so I did self pay. The GERD is worse now. I am now in the process of getting all the requirements accomplished to get the RNY I believe this will help solve my acid reflux and get the damage repaired on the esophagus and finally get to my goal in weight loss, God willing.

Sure hope things work out for you. I know my doc said she will do a peer to peer on the phone if they deny my request. I'm sure your doctor will do the same for you. Also, there are Bariatric Attorneys out there I hear that will fight for us, if need be. Blessings to you gypsyqueen80!

Virgie Tschirhart

Lap Band - 2008, Sleeve - 2009, RYN - 2017

Started Program Weight July 13, 2017 - 194.2

Before Surgery Weight December 27, 2017 - 185.0

Current Weight - February 2018 - 161.0

on 8/20/17 11:18 am
RNY on 04/04/17

If your policy has an exclusion against bariactric surgery, then an appeal wont work. I used to do insurace for a bariatric practice, and the only way to get an exclusion lifted is for the employee (you) to contact your employer. I have seen it happen once, but the person worked at a small company, and was able to speak with the owner.





on 8/26/17 12:09 pm

I had the same issues.My Dr did a Peer to Peer review with insurance and they approved it.I had to have hernia repair again and went from sleeve to bypass.I have never regretted it.

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