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Thread: Denied

  1. #1
    Gastric Sleeve Member astallons's Avatar
    I have had a gastric sleeve.
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    Dr. Wells
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    Default Denied

    Tomorrow would have been my surgery day, but insurance had other plans. Surgery may have been denied, but I am not giving up.



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  3. Gastric Sleeve Surgery With Weight Loss Agents
  4. #2
    Gastric Sleeve Member Sandra3's Avatar
    I have had a gastric sleeve.
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    Sandra
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    01/20/2016
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    Dr W
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    Default Re: Denied

    That's so unfair! I hope you will find an other way! Good luck and take care!


    HW : 150 kgs
    09/02/2014 : 142 /1st apt
    01/20/2016 : 134 /surgery
    01/30/2016 : 130 /1st post-op
    02/27/2016 : 126 /2nd
    04/23/2016 : 118 /3rd
    07/16/2016 : 109 / 4th
    10/01/2016 : 103 /5th
    01/21/2017 : 98 /1 year post-op
    February 2017 : 100 lbs lost
    07/22/2017 : 96
    10/21/2017 : 93
    12/22/2017 : 91
    01/02/2018 : 96!! regain (medication)

  5. #3
    Gastric Sleeve Member Pam G's Avatar
    I have had a gastric sleeve.
    Name
    Pam
    Surgery date
    05/27/2016
    Surgeon
    Dr Ponce de Leon
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    Feb 2016
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    Default Re: Denied

    Find out why it was denied and try again. If it's a covered benefit, then there must've something missing.




    HW: 275
    PreOp: 268 5/12/16

    SW: 258. 5/27/2016
    10 w: 225. Goal 1
    12 w: 222.
    14 w: 216.
    4 m: 215
    5 m: 205
    22: 199.4 10/30 Goal 2
    24: 196
    6 mo: 191
    7 m: 193
    8 m: 184
    9 m: 180 2/3/17. Goal 3
    10 m: 179
    11 m: 171
    48: 170
    1 yr: 166.6. 5/27/17
    13 m: 165.8
    5 y,10 m: 215


    Revised Goal : 200
    "Bonus" Goal: 180

  6. #4
    Gastric Sleeve Member czorin's Avatar
    I have had a gastric sleeve.
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    12/13/2016
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    Dr. Mario Almanza
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    Default Re: Denied

    I was in a similar situation in 2012. After sitting in 6 months of "Bariatric Classes", Blue Cross denied my claim. Not the company itself, but the GROUP that my government agency chose. No weight loss method of any kind is covered. (No shakes, shots, or weight loss groups at all.)
    My doctor tried re-wording the papers by noting that I'm considered morbidly obese, and listing the health benefits.....nope.
    If you're considering paying on your own, and out-of-pocket-costs, check out weightlossagents.com



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  8. #5
    Gastric Sleeve Member Lisa73me's Avatar
    I have had a gastric sleeve.
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    Lisa
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    01/03/2017
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    Dr. Marcelo Hernandez
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    Default Re: Denied

    I'm sorry that happened to you and I'm glad you aren't giving up...



  9. Gastric Sleeve Surgery With Weight Loss Agents
  10. #6
    Gastric Sleeve Member Christie13's Avatar
    I have had a gastric sleeve.
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    Christie
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    11/03/2016
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    Dr. Wright
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    Default Re: Denied

    You need to find out your insurance companies requirements. I knew mine because my surgeon's office discussed them with me. We knew we had to follow them to the letter. The first time we submitted we were missing a form and they had to resubmit. But since we had ensured all the requirements were met I was able to get approved. Is it your weight possibly? I could not be under 40 BMI if my insurance was going to pay for it. I'm 4'11" so that meant I couldn't fall below 198 pre approval. Also I had 6 months of being in a doctors care for obesity, 4 nutritionist visits, psych eval, blood work etc. I agree you need to find out because maybe you can resubmit. Fingers crossed for you.



  11. #7
    Gastric Sleeve Member Del1969's Avatar
    I have had a gastric sleeve.
    Surgery date
    12/01/2017
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    Dr. Mario Almanza
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    Default Re: Denied

    I am going through weightlossagents.com. I'm having Dr. Hernandez do my surgery in June. I will be paying on it a little at a time because my insurance wouldn't cover it either. It's going to happen!!



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  13. #8
    Gastric Sleeve Member Pam G's Avatar
    I have had a gastric sleeve.
    Name
    Pam
    Surgery date
    05/27/2016
    Surgeon
    Dr Ponce de Leon
    Join Date
    Feb 2016
    Last Activity
    04-04-2022 11:41 AM
    Location
    Sugar Land, TX
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    Default Re: Denied

    Quote Originally Posted by astallons View Post
    Tomorrow would have been my surgery day, but insurance had other plans. Surgery may have been denied, but I am not giving up.
    There's actually a benefit for paying out of pocket.... No insurance hoops to jump through. Just go to surgeon an git er dun!




    HW: 275
    PreOp: 268 5/12/16

    SW: 258. 5/27/2016
    10 w: 225. Goal 1
    12 w: 222.
    14 w: 216.
    4 m: 215
    5 m: 205
    22: 199.4 10/30 Goal 2
    24: 196
    6 mo: 191
    7 m: 193
    8 m: 184
    9 m: 180 2/3/17. Goal 3
    10 m: 179
    11 m: 171
    48: 170
    1 yr: 166.6. 5/27/17
    13 m: 165.8
    5 y,10 m: 215


    Revised Goal : 200
    "Bonus" Goal: 180

  14. #9
    Gastric Sleeve Member astallons's Avatar
    I have had a gastric sleeve.
    Surgery date
    09/11/2017
    Surgeon
    Dr. Wells
    Join Date
    Nov 2016
    Last Activity
    02-17-2019 09:09 PM
    Posts
    39
    Said "Thanks" 43 Times
    Was Thanked 26 Times in 22 Posts
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    Default Re: Denied

    Guess who is back at it!!! I have re-submitted everything and waiting for approval!! Thanks for all of the encouragement and suggestions...I haven't been on here in a while so I am just now seeing some of these responses. Everything happens for a reason, apparently my reason is because I was going to be promoted at work and having to take time off like that wasn't feasible. Also, my husband had to have a small surgery, so that puts my out of pocket payment a lot less than what it would have been if I had the surgery in December of last year. Again, I was bummed when I was denied before, but all good things come to those that wait!!! :-)



  15. #10
    Gastric Sleeve Member Pam G's Avatar
    I have had a gastric sleeve.
    Name
    Pam
    Surgery date
    05/27/2016
    Surgeon
    Dr Ponce de Leon
    Join Date
    Feb 2016
    Last Activity
    04-04-2022 11:41 AM
    Location
    Sugar Land, TX
    Posts
    1,537
    Said "Thanks" 678 Times
    Was Thanked 771 Times in 544 Posts
    Said "Welcome to Gastric Sleeve" 57 Times
    Blog Entries
    12

    Default Re: Denied

    I was delayed for other reasons, not insurance, but it was two yrs delayed. I figured it was a reason, but it worked out for me. It is your turn now!




    HW: 275
    PreOp: 268 5/12/16

    SW: 258. 5/27/2016
    10 w: 225. Goal 1
    12 w: 222.
    14 w: 216.
    4 m: 215
    5 m: 205
    22: 199.4 10/30 Goal 2
    24: 196
    6 mo: 191
    7 m: 193
    8 m: 184
    9 m: 180 2/3/17. Goal 3
    10 m: 179
    11 m: 171
    48: 170
    1 yr: 166.6. 5/27/17
    13 m: 165.8
    5 y,10 m: 215


    Revised Goal : 200
    "Bonus" Goal: 180

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