Question:
Don't know what to do? insurance denial

I had an appt. yesterday with the surgeon and she completely told me that I would not beable to have the surgery...the insurance would not approve it. And that was it....she wouldn't even try.    — Jaime P. (posted on January 13, 2005)

January 12, 2005
What specifically does your policy say? If it's an iron clad exclusion it may be difficult to impossible but not even trying is nuts in my opinion. The bottom line is that surgeon does not want to deal with any hassles. There are many people on this board who had iron clad exclusions that managed to get surgery by having perseverence. So do some research on your policy first and then consider finding another surgeon. The issue might be that what her contracted amount with your insurance is, she won't do the surgery for.
   — zoedogcbr

January 12, 2005
I had a similiar situation with my plastic surgeon and my abdominoplasty. She did write a brief letter that got an automatic denial. I, however, submitted my own letter to the insurance company and got my OWN approval. You can do the same. If you really, really want this surgery, you better be your own advocate or you won't get anywhere! Good luck!
   — koogy

January 13, 2005
Jaime, From your profile your BMI is slightly on the low end, but do you have comorbidities? If so, then insurance may well cover. It's important to remember that insurance is a PRODUCT and different purchasers of this product have different attributes written into it. Some insurances cover WLS no problem. Others won't even if there is imminent threat to your life. Some of us end up self-paying because the insurance issues. I did - I went to Spain for my surgery (with Dr. Aniceto Baltasar) - it was a huge blessing in disguise that my insurance didn't cover, and I'm now daily thankful that it didn't! I'd recommend calling your insurance provider and asking them what the policy is for WLS. Then, if they do cover WLS and you qualify, then consider a second opinion - seek out a different surgeon. If that still doesn't work out, then investigate the possibility of self-paying for surgery. It's far more affordable than one might think. For my surgery 2.5 years ago for travel, surgery, etc - we paid $15,000. And, got one of the world's best surgeons to boot! Hope that helps! Blessings, dina
   — Dina McBride

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