Denied

Well I got the news from Dr. Loggins this morning, my insurance has denied me.  They told Dr. Loggins that they do not cover weight loss surgery and they would not even listen to anything he had to say about it.  He did tell me I could try to appeal the decision but wasn't sure if it would work.  I am so depressed and have been crying most of the morning, what do I do now?

OMG, I'm so sorry this is happening to you.  I have Loggins also and they called the insurance before I even started all the process to see if they covered wls, I am surprised that this has happend.  I would deffinately try to appeal, what do you have to loose.  Did they have any suggestions, as to what to do?  I'm sure something will come up, even if its not right now, just be patient.  just stay possitive and keep fighting.  hoping and praying this will happen for you.  Your friend, Cheryl

don't give up. call your insurance company and ask for a copy of your policy. sometimes they have a website with that information. after go to the main forum for suggestions. i know they talk about this there and have come up with some appeal letters you may be able to use. exhaust everything so you know you gave it your best shot. there may be a hole in the policy somewhere so you can get this done. don't give up!

Wait wait, just a minute, TAnya also had Harvard Pilgram, why would they tell you they don't cover WLS??? something isn't right here.  Don't get too worked up yet.  CAll them and give them a little mind...this will work out.

Fight it with all the ammo you have. There must be a way. Call your ins company every day and ask why they do not cover wls. It is cheaper in the long run  for them. Please don't give up we are all here for you.

What insurance do you have?  I checked my policy before even starting the process.  I am surprised they would have you go through the whole process if it was never even covered in the policy to begin with.  I agree.  Go for the apprakl and see what happens.   Any way you could switch insurance??  Like do you get it from your hubby?  Could you get it through your work?  Even if temporaryily it is higher premiums etc?

I do plan on appealing the decision, apparently there are different policies and rules for every insurance company and depending on what you employer chooses for benefits from the insurance company that is what  is and is not covered.  Apparently the company I work for did not opt to have Harvard Pilgrim cover weight loss surgery in their package.  The company my husband works for doesn't really have an insurance plan, he works for a small trucking company.  Please keep me in all your prayers and hopefully everything will work out in the end, there has to be a way for me to have this surgery.

I feel so much for you, it must be so hard, after all the work you've done.  did Loggin's call your insurance before you started everything.  they did for me.  and they told me it didn't cover, for Nurtrition appt.,  but at least I was informed.  seems crazy your insurance would pay for all your test, then deny, what a waste of money as far as they are concerned.  sometimes they just don't make any sense. (I understand is wasn't a waste of money, cause all those test are not usually given by your pcp, but still).... keep up the fight girl.

I am so sorry you are going through this.....if just doesn't seem fair.   Their are quite a few people on the RNY board that have successfully appealed their insurance - I'm not much help here because I don't have the experience, but people on that board are very helpful. There is also an insurance board that might have so good info for you. I'll keep my fingers crossed for a successful appeal.

Oh, I am so sorry! I can imagine how disappointed you are.  Don't give up!  Is selfpay an option?  My surgery cost with no complications was $11500