Well, I was turned down by insurance

zzobe
on 3/31/14 8:00 am

Got my first official "you've been turned down" by my insurance company today. From what I can tell, I was turned down because "there is no documentation to suggest that you BMI has been above 40 or above 35 with comorbidities for at least 12 months". The letter is long but most of it just lists what needs to be done . I'll call my weight loss surgeon tomorrow and see what they say I should do. I'm guessing that my internist will need to submit my weight records for the past year. Is this response typical from an insurance company? What are your thoughts about this? Thanks.

(deactivated member)
on 3/31/14 8:21 am
gabby169kitty
on 3/31/14 8:44 am

It sounds like a easily winnable appeal. Hopefully it will be as easy as sending your weigh records. 

poet_kelly
on 3/31/14 8:52 am - OH

It's a typical response when someone fails to provide documentation that they meet the criteria, like records verifying your history of obesity if they require that.  They can't approve you without the proper documentation.  It's typically an error on the part of someone at the surgeon's office, who should have checked to see what documentation was required and then made sure it was all being submitted. 

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

zzobe
on 3/31/14 8:54 am

Yes, I'm thinking it's no big deal. Already spoke to the insurance company. Wanted to double-check the reason, but he couldn't tell me anything specific. I'll call my DR. first thing tomorrow and get this going. Seems like it should be easy. 

Hislady
on 3/31/14 9:37 am - Vancouver, WA

One thing my insurance co. denied me on was weight records too. My primary nurse just sent a list of weights to them and they wanted the actual copy of the doctors notes. So you might want to make sure they do that also just so you don't have another denial. Good luck to you, patience is needed all thru this journey, even after surgery!

gabby169kitty
on 3/31/14 10:13 am

My program checks for insurance coverage before they schedule a consult. They also get a print out of the requirements. The coordinator told me they have always won the appeals on the first try. A little extra step in the beginning can save a lot of work at the end.

 

gram247
on 4/1/14 3:32 am

Don't let them get away with this refusal. Fight it. Have you physician & bariatric doc push for approval. This is lifesaving surgery! The news reported that bariatric surgery was more successful in controlling diabetes than medication alone. 

Good luck.

 

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