I have been on this website for a few months, and today i found this group.
I live in Philadelphia and have been in the process testing, doctors visits all the moves to get Gastric Bypass. I got clearance from all, all good to get but, I have Independence health insurance and my surgery has been denied.
All of this process to get denied. I go to temple Hospital Bariatrics center there answer to my denial was get another insurance or pay Cash for the surgery. That was a let down!!
So i called my health insurance and was told by them that my surgant can try to do a Peer to Peer with the insurance and maybe my insurance will give in and give an approval.
I wanted to ask if anyone here has had this issue with being denied and if so what is an option in getting thru with this to get approved. Thanks in advance.
Hello nice to meet you aswell.. I did not know there is a barix clinic in Langhorne, i will check into that.
Thanks and Blessing.
Just wondering why they denied you? Is there specific language that says bariatrics are not covered? Is there a requirement that you didn't complete for approval? Do they say you don't weigh "enough" to qualify?
I did not have to deal with denial but Capitol Blue Cross did everything in the world to delay my approval - it took 18 months. And right after my surgery our policy was changed to remove any coverage for bariatrics.
My insurance replied saying it was not in my coverage benefits and that they would consider approving if my Doctor does a peer to peer. I'm still waiting for my Doctor to do that, but i was interviewed by a case worker who is fighting on my behalf also waiting on reply on that.
Is your insurance a state insurance ? PA state doesn't cover. What is peer to peer?
At the time i had keystone healthplan east purchased thru the marketplace.
A peer to peer is when your doctor goes on your behalf and deals it out with the doctors on the insurance plan to approve what surgery you are requesting to get done. Some insurance companies just want to complicate things only will approve if you and doctor show it's a medical necessity.