Has your insurance ever declined you?

I have been very anxious about hearing from the insurance. I knew that my surgeon's office submitted last Tuesday. (To BCBS of IL) So I read that someone wanted to know so they called their insurance directly. So I did....and I got the news...DECLINED - NOT MEDICALLY NECESSARY.

I immediately called my surgeon's office and they got their letter yesterday. They told me that they will call my insurance to get some added information as they didn't say why it wasn't medically necessary.

So my question for all of you, have you ever been declined and what happened afterwards? Did it work out through the insurance or are you having to self pay?

I am hoping for the best right now, but it is really hard today.

Mine declined me and I had to pay for mine in full. It did pay for some other things like lab, stress test, etc

My husband and I were declined in Sept of 2005 after doing the 6 month pre-op diet.  I even checked with my HR department prior to beginning to ensure it was covered.  Once they received our packets they said it was denied as not a covered benefit.  I later found out that when your company is self insurred, they use companies like BCBS to handle everything for them.  The company tells them what they will and will not cover but all money paid for claims is actually coming from the company.  

Fast forward to 2012.  New benefits with same company under a new name and it is covered.  The bummer is that he and I were both 100 pounds heavier this time. (He was 350 and I was 250)  

My husband and I just had our surgeries a month ago and I am actually thankful that we had the choice of a VSG verses RNY.  We would not have had that choice in 2005. 

Is your insurance through an employer?  If so, find out if they are self insurred.  You might be able to talk to someone in your HR department and see if they will make an exception.  I should have tried back then but I was too embarrassed about my weight to even try.

I really hope you will be able to get them to cover you.  We waited so long for this to finally happen and I know how hard it is to be denied when all you want is to have help to live a healthier life!

I was declined 3 times. Once by United HC PPO of IL, Aetna PPO and United HC POS. All denied me. BCBSIL did not deny me. They approved me after I saw a Psychologist. Good Luck! I hope this can be reversed. best, Sharon

Thanks Sharon. I already saw a Psychologist. I am hoping that maybe they didn't get all the pages or with a little push they will approve me. It is just weird that they were faxed everything on Tuesday the 3rd and on Friday the 6th, the letter was sent out. Why was it so quick?

Once I heard the news I immediately jumped on here and started posting. I have been getting encouragement on here it has really helped.

-Jennifer

Thank you so much!

I will file the appeal if my surgeon's office doesn't get anywhere. I will give them  2 days to find out what is going on and then by Monday I am calling! I even pulled up the full policy online (as they showed me where it was) and read through it to make sure nothing was missed. Sure enough...I did everything!

I was denied a couple of times but it was resolved as soon as the doc sent additional info. Sometimes they just on't get or see all the info sent. BCBS of IL was my ins. too and they were good about working with the docs office. Here's hoping yours comes thru too!

I was denied because I missed one appointment with my family doctor. My surgeon's office suggested I write a note explaining why I missed one appointment. They resubmitted my request with my letter an I was approved. Hang in there. I think most surgeons' offices have dealt with insurance denials and are helpful in getting you approved.

Yea, I had the sameish experience as you did. My insurance company wouldn't approve mine until they had more documents. I'm not sure what documents those were, but anyway.....mine finally got approved today. Just keep calling the insurance and the surgeon's office and stay on top of them!! I found out today that I am approved, but on my letter it says for LAP BAND surgery. I about blew a gasket or two. WTF! So you have to stay on them or they will mess everything up!! I am going to make sure the day of my surgery that the doctor knows I am getting the SLEEVE done and not the LAP BAND!! I swear these people are sleeping some days!