Denied...

DonnaMaria
on 9/10/13 6:12 am
I just found out my sleeve surgery was denied. Appeal takes 60 to 90 days. At this point I would just be happy to keep my band but the doctor got insurance approval to get it out. What am I going to do? Any suggestions?

 

Chrissy W.
on 9/10/13 6:22 am - Indianapolis, IN
VSG on 07/01/13

You probably are, but see if your surgeon has an insurance specialist and USE THEM. Appeals do NOT have to take that long. I was denied twice and it only took a few weeks to straighten it out. Good luck!!

VSG 7/1/13 with Dr. Jack Rutledge 28 y/o female - 5'10" - HW: 298GW: 174 - SW: 290 (-8) - M1: 262 (-28) - M2: 247 (-15) - M3: 235 (-12) - M4: 228 (-7 ~First Stall: almost 2 wks~) - M5: 218 (-10) - M6: 209 (-9) - M7: 199 (-10) Onederland on 1/31 - M8: 196 (-3) 100 lb total loss on 2/2 - M9: 192.6 (-3.4) - M10: 188.6 (-4) - M11: 182 (-6.6) - M12: 175.6 (-6.4) - M13: 173.8 (-1.8) CW (7/8/15): 167 - GOAL reached in 1 Year and 25 Days! - TOTAL WL - 131 lbs  

DonnaMaria
on 9/10/13 7:08 am
Thanks Chrissy!

 

MsBatt
on 9/10/13 6:46 am

Why did they deny it? I'd certainly go ahead and get the Band out while I had insurance approval---it's going to have to come out eventually anyway.

noftessa0401
on 9/10/13 8:40 am - San Diego, CA
RNY on 12/27/12

What was the reason for the denial?  Hopefully, it was just an administrative issue (e.g. they didn't receive all the documents they requested, etc.)  And yes, I concur that you should use your surgeon's insurance people - they know (or should know) all the ins and outs.  Good luck!

HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"

M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)

pineview01
on 9/10/13 9:07 am - Davison, MI

I was denied for the sleeve surgery as my insurance had gone to a once in a lifetime policy.  I was able to be approved to get the surgery for band removal.  I got the band out as I couldn't take the medical problems and couldn't take it anymore.  I also appealed to get the sleeve after the removal as I had shown medical need for the band and could prove medical need for removal.  I called head of CS and also was able to talk to head of appeals and they talked to my center and their medical review person.  I lucked out as the head of referrals had a band and had to have it out within 6 months.

I also had to go thru the whole process to get the sleeve I had to go thru the first time to get the band.

Lot's of pain and hassle but, was the best thing I have done.

Good luck!  Get that band out, get any documentation they need and appeal.  Just a FYI my centers current Insurance specialist was worthless.  I did it in spite of her.

BAND REMOVED 9-4-12-fought insurance to get sleeve and won! Sleeved 1/22/13! Five years out and trying to get that last 15 pounds back off.

DonnaMaria
on 9/12/13 9:37 am

My BMI is 34 so I don't know if that is why they denied me.

Thank you for all your responses!

rtm
on 9/12/13 9:47 am - NY
VSG on 08/20/13
My BMI was 33 and I was denied for sleeve but approved for band removal because my insurance company claimed that with a bmi under 35, the surgery was not medically necessary and investigational. I went through the internal appeal, a peer to peer and then asked my surgeon to write my own external appeal. I did a bunch of medical research and found helpful journal abstracts. I also pulled up my company's bariatric surgery policy and showed how complications were grounds for removal and revision. The company claimed that my swallowing issues which made me sick daily couldn't be seen on any tests so they were skeptical. Ultimately, I won the external appeal and just had my surgery on 8/20. It's totally worth it. From original denial through the layers if appeals it took me about 2 1/2 months. If you'd like to see the letter I put together, PM me. Good luck!
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