Approval/denial

Oliviawashere
on 11/19/14 12:18 pm

has anyone been eligible for surgery, had it in writing, then turned around to be denied for some reason? And if so how or why?

poet_kelly
on 11/19/14 10:30 pm - OH

I don't understand why it would be denied unless something made you ineligible. 

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.

 

Cathy W.
on 11/19/14 10:31 pm

Do you have it in writing from the insurance company and then they denied it? 

Valerie G.
on 11/19/14 10:57 pm - Northwest Mountains, GA

Well of course!

Many insurance companies have you jump through many hoops before they will approve you for surgery, such as medical clearances from different specialists, a sleep study, a psychologist, and up to 6 months of supervised weight loss.  Even if you meet the 'qualifications' they will deny you for skipping these steps.

If your employer did not add wls in their insurance program, then you can be denied because of that, no matter what.

Valerie
DS 2005

There is room on this earth for all of God's creatures..
next to the mashed potatoes

Oliviawashere
on 11/20/14 12:33 am, edited 11/20/14 12:34 am

No, I am just always one of those 2nd guessers. Worry Warts, may have you! haha. I got a letter saying I was eligible for surgery. I completed my steps of 6 months diet program & psychologoical eval. I was told I may have to do a 7 month for weight loss (from the surgeons office) so it was a complete 6 months, not just 6 months of recorded weights. However all that was submitted was 6 months of recorded weights, and I was still approved, so I was wondering if they would turn around and deny me, if I didn't have 6 full months of weight loss.

Mary Gee
on 11/20/14 2:33 am - AZ
VSG on 05/14/14

A letter saying you're "eligible" is not the same as an approval.  The approval comes when you've met all their requirements.

For my six month diet letter, I got a letter from my pcp outlining my visits to him and setting forth my weight.  That was enough for my insurer.

       

 HW: 380 SW: 324 GW: 175  

 

 

 

 

 

 

 

Oliviawashere
on 11/20/14 4:47 am

I *met* all the requirments. They wanted 6 month supervised diet, the sheet was filled out for all 6 months. However my PCP counted our first visit as the first weigh in. That was submitted to the surgeon who submitted that, along with my psychological eval. My surgeon called to tell me I was approved for surgery, and I got a copy of a letter that was sent to the surgeron saying I was eligible for services. How is this not an approval? What am I saying is, theres no reason that they would approve me (which I believe I am), and then go back to the drawing board, and deny me? I guess I am just overly worried.

Hislady
on 11/20/14 1:44 pm - Vancouver, WA

You can be eligible for the services without being approved. My approval letter used the exact wording of you are approved for XYZ surgery. What your surgeon got was a letter saying you are eligible, meaning you are covered for the surgery once you complete the requirements and they are submitted to the insurance company, then they have 30 days to let you know if you are approved or if they need more info. They should send you a letter too if you are approved so if only your surgeon got the letter I'm thinking that is to tell him that you have the correct type coverage that covers bariatric surgery and now he can send in what ever requirements they ask for. Insurance is very tricky and specific, that is why they usually have a certain person handle all of it. Good luck but you aren't approved until you have your own letter in your hands.

Oliviawashere
on 11/25/14 12:24 am

Whose requirments? My insurance companies requirements (which I have fullfilled) or my surgeons requirments? I called UHC and asked them if i was approved for surgery, and she said yes. When i asked her if being eligible in my letter was the same as approved, she also said yes. So do you think she was lying, and I should be still waiting for a letter of approval?

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