Insurance probIems for my VSG

Hello everyone!!! I am new here and am going through the process to have a VSG with Dr Oliphant. I thought I had done everything that insurance and the Dr asked of me, but just found out over the holidays that my insurance has denied my pre-certification for surgery. This is very frustrating. It seems you are so close and they enjoy yanking it away from you. I have Aetna insurance and they do pay for the gastric sleeve. I was just wondering if anyone else on here has Aetna and if they had problems, and how they got them to pay for it. They say they want 2 years of height and weight management, which my FP has, and 3 months of counseling so I can maintain after the surgery. I have done the three months with my FP. They said I needed a peer to peer with the Dr and insurance's Dr. Well I thought maybe my FP would have all the info they needed so he called them and they informed him that it did not matter what they told him I was still denied. You would think that since he has been my Dr for over 25 years that he would have all the info they need. Then I called Dr Oliphant 's office and told them that he needs to do the peer to peer call. I am so confused with listening to the insurance lingo because I do not understand it all. If anyone else has had this problem, please let me know how you resolved. I have also put in for an appeal. I have health problems that are obesity related, and a BMI of 46 and they turn me down. HELP!!!!!! Any ideas????

Does your surgeon's office have an insurance coordinator?  If so, call that person and ask them to find out exactly what is needed and how that documentation need to be provided.

 It sounds like your doctor has told you that he needs to do something (the peer-to-peer call).  So if that's what's holding things up, just find out when he will do it, and when he he will be submitting it to your insurance company. 

Usually the surgeon's know exactly what needs to be documented, so just check about the peer to peer and see if that's all they need.  At this point, it seems like it's just checking off all the boxes of things that the insurance company requires, and making sure those things are documented they way they want.

Good luck!

Hi - I have Aetna and was able to get it approved.  I had to do a 4 month WL program, provide 3 years (I think - may have been more) weight history, can't remember the rest, but it went through fine.  Talk with the insurance person at your surgeons, they will help you figure out what you need.

I know it can all be frustrating - just try to be patient - it will all work out!

I have been in touch with my Dr's surgery scheduler and she has helped somewhat. But I just found out tonight that she no longer works there but they did give me the new persons number. The person I talked to said they would tell the Dr that he needs to do the peer to peer. Bad thing is he only has till Monday the 7th to contact insurance because I have been given the run around so much that time has been wasted. I am just so frustrated and my age is against me to. I am 55 and I think my insurance only pays up to age 55. SIGH!!!!! I am trying so hard to be patient. I just want this so bad and feel as if it may not happen. Thanks for your help.

I'm sorry you are having so much trouble. My insurance was a pain in the but also, though yours requires a lot more than mine did. At any rate the best thing to do is just keep at people. Call everyday till the doctors office or insurance company gets done what it needs to so you can get approved. Show them you mean business and are not taking no for an answer. I know, easier said than done, but you can do it.

Praying things begin to run smoothly for you and you are soon on the losers bench!

I have Aetna and it was listed as an exception on my policy.  it really depends on the details of your plan. The crazy part is I got this from work as an insurance agent and it has been the worst insurance i have EVER had. Hope everything works out for the best. 

If they want a history of weights they may want the doctors actual notes, that held me up for awhile. My nurse sent a list of weights and dates but they wanted the a copy of the actual docs notes. I wouldn't think age would make a difference but it all depends on your particular coverage. Good luck, just keep pushing!!!!