Health Net Denied

Well after waiting since August 2010 and jumping through countless hoops I have been denied for VSG.  Bummer. 

Anyone have experience with Health Net and VSG?  I am really not interested in the other procedures.

Thanks!

Sandy

 what criteria did they base their denial  

Bummer,  i know exactly how you feel.  I have anthem blue cross and in 2/10 i was denied.   The reason they gave was they consider the sleeve experimental.   I appealed and won my appeal and a lot of us have.  What reason did they give you?  If because they say its experimental that's an easy one to appeal.   I'm so sorry this happened to you.   The insurance companines are starting to approve now but we need all of them to get on board.   Let me know if i can help in any way.  If you want a copy of the letter or whatever   :o) jeani

So sorry to hear that!  You must appeal.  I was covered under Healthnet at the time I started this journey in June of 2010.  I jumped through all the hoops and my surgeons Asst. was awesome about pushing through all Paperwork and telling me what I needed to do.  They covered mine.  Maybe it is the specific plan you are on? 

Im sorry to hear dat, OMG I have health net too and jus submitted to day. I would take that advice from Jeani I believe who commented right above me. She says she was denied and can help with letter. Hope everything works out for u.

Jeani Imma keep my fingers crossed that I dont get denied, but if I do I will be looking for u to help me as well with denial letter.

I will be praying for u Sandy.

Mine was denied at the beginning of March, thru HealthNet,  they said because the VSG has not been around long enough.  I appealed it and it was approved 2 weeks later because I take NSAIDS due to my bad menstraul period and so therefore I am a better candidate for the VSG then the Gastric.  and I was sleeved 3 weeks later.

Stay positive and don't give up.  You are in my prayers!

HealthNet approved me because I need to be able to do steroids if necessary (for asthma, though its so much better now) and because I have celiac (and there is so much less malabsorption with the sleeve) - i would appeal if you can based on any specific medical grounds. don't give up!!! i will be thinking of you.

Thank you everyone.  I am not really upset.  I just thought by now I would be on the loser's bench.  I get something in my head and want it NOW.  Haha...

They denied it because:

1. They consider it investigational and not medically necessary. 

2. They also stated that I have no special cir****tance for which the band or RNY are contraindicated.  Contraindications include anemia, which I am.

I will get in touch with my surgeons pre-op assistant tomorrow and see what she recommends.  I will appeal.  If nothing else, I have the time.

Worse case is I have all the pre-op tests complete and I self- pay.  Obviously I would rather have my insurance pay.  Also I feel like I wasted time jumping through their hoops if I were going to pay for the procedure myself.  I guess one good thing is while waiting I was able to research my procedure better.  I was originally sold on the band.  After visiting the forums for the last 9 months I have decided VSG is for me.

Thank you all for the kind words even those silently routing for me. ;)

Sandy

Keep up the appeal process- they insurance worker's job is to deny as much as possible.  Work with the doctors office to beat them.  Good luck!!!

I have health net and got approved pretty quickly.  They have my comorbidites as sleep apnea and asthma.  I got one of my Drs to write a short note saying VSG was the preferred surgery due to my having malabsorbtion issues.  Do you have a medical group associated with your health net ins.? I have Hills Physicians thru Health Net and they picked up the hospitalization and all testing and HealthNet picked up the surgery and Drs charges.