Question:
Is it true that practically everyone is denied by insurance the first time?
— Shannon B. (posted on August 18, 2003)
August 17, 2003
I was approved in 24 hours after the preliminary letter (no test results)
was sent. For me, it was a miracle.
— Happy I.
August 17, 2003
Hi, My insurance Blue Cross Blue Shield Federal Employee program states
clearly in the policy book, that if one is over 100 pounds overweight that
bariatric surgery is covered. I had no problems at all. I did not even
have to have prior approval. I am very blessed with this insurance. Read
the policy book carefully some have provisions for bariatric surgery. Good
luck and take care
— Karen Renee
August 17, 2003
I think it depends on the insurance copamy. Seems that the ratio is about
half and half. I have UHC and was approved at two weeks.
— Delores S.
August 17, 2003
Hi. You should check your insurance company to see if it is covered or not.
In my insurace book it gives the requirements. I met the requirements and
was approved after the first letter. It did take them 2 months to approve
me though.
— AmyWollet
August 17, 2003
I was approved by One Health Plan/Gen. American on the first try, they did
take 12 weeks and asked for a psych eval, TSH and nutritionist consult.
— plsmom
August 17, 2003
I have BCBS and was approved the first time within several days. I had a
BMI of 38 but also a co-morbidity of diabetes. I am very thankful that the
insurance process went so smoothly for me.
— Judy R.
August 17, 2003
We (DH and myself) were both approved after the first letter. Only took
about 2 weeks. I really love my insurance company. They are very helpful
and kind, AND I don't have to fool with the refferral system, I pick a dr
and go to whomever I wish.
— Pookie B.
August 17, 2003
I was approved 4 days after submission, on the first try. Alliance PPO -
CBA.
— M B.
August 18, 2003
I needed no prior approval from my insurance-Medica Choice. They figure as
long as your surgeon deems in necessary, why would anyone go through it if
it wasn't? Get on the phone with your insurance company and ask what their
requirements are... that way you will have your ducks in a row BEFORE you
submit for approval.
— Peg L
August 18, 2003
No, it is not true. Everyones expereince is different (even sometimes with
the same insurance company) You can do your homework by readying your
policy manual to see what is covered and asking specific questions of your
insurance company about what is/isn't covered and what the requirements
are. You can then discuss it with your surgeon. They are required by law
to give you this information, so don't let them put you off. Ask if they
cover weight loss surgery, ask WHICH ones they cover. Tell them you want
SPECIFICS of ALL requirements if they say they cover weigh loss surgery.
This will help you to know what you are in for as you submit for approval.
Good luck.
— LMCLILLY
August 18, 2003
I was approved in less than 24 hours first time out with HMA insurance (a
First Choice provider). It really depends on who you're insured thru and
who you work for. Good luck!
— [Deactivated Member]
August 18, 2003
Nope not true. I was approved firs try through Aetna. Do/have everything
they require and you should have no trouble. Good luck!
— SarahC
August 18, 2003
Not me - got approval right away because I knew their criteria and got all
my documentation together the first time out.
— bethybb
August 18, 2003
I was approved first time by Oxford Freedom Plan. As others have
mentioned, investigate the requirements of your insurance company and have
all documentation prepared for submission to them in advance.
— Fixnmyself
August 18, 2003
I got verbal approval the same day that I got the paperwork into the
insurance company (Private Healthcare Systems-MD Plan). 3 days later..the
approval letter was in my mailbox.
— Schtina J.
August 19, 2003
Shannon, I think everyone's experience is different. I was approved on the
first go around, with Healthnet HMO in California. One thing that I did
(in addition to a year of research) was that I submitted my own letter
along with all of the othe required documents. My letter covered the
issues from the patient's perspective as opposed to the Doctors, on how
this affects my ability to live my life. I don't know if it helped for the
approval, but it sure did help me feel like I was taking charge of my own
approval!
— Stacy E.
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