Insurance Denied!!

[vrodge02]

I think it's fairly common but wanted to throw it out there and see who else has had insurance denial issues. I was just denied because I gained weight during a 6-month weight loss program period. I ended up with a net zero weight gain at the end because I also lost weight, but UHC denied because I gained during the period, regardless of losing. This technicality allowed them to overlook co-morbidities. I am appealing, but not sure what the outcome will be. Anyone have any similar experiences?

Thanks

Vince

[azjeffy]

They just submitted me for approval, and I am nervous about it. Good luck with your appeal! My Doctor's staff warned me that if I had any weight gains during the 6 month period, that my 6 months would start over. They told me UHC requires a loss at every visit.

[Christie13]

Sorry to hear that. I am kind of surprised that your surgeon's office didn't work with you on those numbers as they make their money off the actual surgery. I know that my insurance also clearly stipulated that if I gained any weight during the 6 month process I would be denied. I was very, very cautious about that. I made sure to follow all the requirements to the letter. I think at this point the only thing you can do is start the process over or self pay.

[Kristi7928]

I was denied by my insurance and denied by Medicaid. Also, lost my appeal with Medicaid. I started the process in September, but I refuse to give up this fight. I have two doctor's that say it is medically necessary and still got denied.

I have had a lot of down time being in the hospital this week since Tuesday so emailed my surgeon's nurse to resubmit to Medicaid. She emailed back and said have my primary do it since he submitted last time. He emailed back and said have the surgeon's office do it. Hoping she got it in today.

Surgery is going to put off to like August or September whether Medicaid covers it or if I self pay due this recent health set back with my feet (caused by the wound clinic). We all fully believe that the weight loss will help, just gotta get over yet another bump in the road. Been many these last 9 months.

Don't give up and I wish you luck in your appeal.

[vrodge02]

thanks for the reply guys. i figured this was common. 1st appeal was denied but a 2nd level appeal was sent by my surgeon yesterday. i'm not confident.

[nlee]

I just received my approval a couple weeks ago. I started the 3 months dr supervised weight loss program in December 2017. I went to the seminar last summer and was told how strict insurance companies are on NOT gaining any weight during the weight loss program. At the time I was with Aetna- which required a 6 months supervised diet. At the end of the year I was forced to change insurance plans because of a reduction in service area by Aetna. The surgical group advised me to go with a company that only required a 3 months supervised diet. So that's what I did, it's much easier to not gain when you only have a 3 months window to work with. Even still, I finished my diet in March and the rest of the requirements in May, it still took 2 months to get the approval from BCBS. So this may be option for you, if you keep with the denials and you're able to change insurance companies at some point. I know my employer has open enrollment in November each year. It's an option.

[Joyzeegrl2]

I'm so sorry that happened to you. That's really disappointing. I have UHC and they must have different plans. I was not told I couldn't gain wait and didn't have a weigh in. Except at the end. I did lose but not much. My doctors office however did say that if you gain weight prior to surgery it may be difficult to do with the fatty liver. Maybe they would accept you if you lost weight over a shorter period, like 2-3 months.

[CamCat]

Don't let their denial put you down... keep up the fight!

[sraebaer]

It seems odd to me that a person with the disease of obesity would have to lose weight to have surgery. I was self-pay so had no "hoops" to jump through. Hope things work out for you!

[simplyseahorse]

I was denied by UHC as well but it was for not having documentation of my weight as obese over past five years. My surgeon had to do a peer to peer to have it overturned. I guess if they deny you again you will have to restart the process? The good thing is that they cover once they approve.......I was authorized for one night stay in hospital, but when it turned into four, they paid. Good luck with it..........