I Was Denied Gastric Bypass Surgery, Now What?

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My assurance company said that even though they cover weight loss surgery, my course did not. My assurance only covers weight loss surgery if I have more than two co-morbidities. I need to show proof that I have been obese for at least five years. I haven't been taking pictures of my scale!

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How is I Was Denied Gastric Bypass Surgery, Now What?

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These are typical complaints heard from people who have struggled unsuccessfully to lose weight, finally made the big decision to endure a life changing procedure, and are subsequently denied coverage by their assurance carrier.

The data has proved that weight loss surgery is a life extending and often life saving operation. Medicare has recently decided to cover weight loss surgery. Most major assurance fellowships cover weight loss surgery - Humana does, Cigna does too. But then why do so many people still get rejected?

Even though assurance fellowships realize it might be useful in the long-term to pay for these life changing procedures, that doesn't mean they will rush to spend twenty to thirty thousand dollars on a surgery for you next week. So now that they've denied you coverage for this procedure, what do you do?

Step 1: Find out why.

Insurance fellowships are required to explain in writing why you were denied coverage if requested.

Step 2: Is the imagine legitimate?

Occasionally it is - Your Bmi (Body Mass Index) is 35 and last year it was 32. The course states that your Bmi must be over 35 for 2 years (this is typically evidenced by medical records - i.e. Visits to your Obgyn, etc.)
Sometimes its not - Your course covers weight loss surgery, but will not cover whatever with an eating disorder. Most of us have some sort of unhealthy relationship (disorder) with food, and that's the imagine we are here. I was an emotional eater, and a Tv eater, and a integrate of others that I can no longer recall.

Step 3: If the imagine is legitimate then impart the policy, make sure that when you motion or effort coverage again that you do of course meet the criteria and you have written documentation. And that documentation should prove without a doubt that you qualify. Typically, you are allowed one motion each year per course request. So, I strongly urge you to come back fully prepared so that there isn't a occasion that the assurance company could deny your pre-authorization request.

Step 3b: If the imagine for denial was a matter of botched paperwork or the fine print in the policy, reconsider the options below.

Because your surgeon's staff probably filed the primary paperwork, do you have faith in them to re-file? reconsider a more experienced surgeon if not. Because of sheer volume, the staff is often very familiar with the appeals process.
Consider a lawyer if you feel like the assurance company rejected you to save money rather than cover a medical course that you qualify to receive. Often, it's a uncomplicated matter of thoughprovoking with the help of a lawyer. A quick Google crusade for bariatric lawyer will bring up some specialists in the field.

Step 4: Wait.

If Step 3 didn't work or you of course did not have coverage in your policy, then wait. Wait until you can convert your course to the Ppo that does have bariatric coverage. If your company doesn't offer a condition plan with bariatric surgery coverage as an option, then call your Hr department. Ask them to strongly reconsider having that as an option. Tell them why its good for the company. You will use less sick days because the sleep apnea is cured and a rested immune system is a strong immune systems. You will have more power because your Type 2 diabetes will be gone. Ultimately, you'll be a happier, more effective you. Finally, if your company just isn't going to offer coverage, then look at your spouses insurance.

Ultimately, the decision to have weight loss surgery is not an easy one. And the assurance process can be equally difficult. But you've made the decision to convert your life. You've decided to have a major surgery to come to be a healthier, happier you. Now its time to decide that you're not going to let an assurance company stop you from getting there.

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