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Insurance Issue

L

Looneyt

Member
Okay Guys and Girls. I have started my journey June 26. My surgeon told me I was considered Morbid Obese for my height and age. That just exersice and diet wouldn't be enough to keep my weight off. I went and did all the testing and gone to all 6 required appointments. My last one was on November 4th. Three weeks later I had gotten a letter in the mail saying my insurance wasn't going to cover it because it wasn't medically necessary and that I had a thyroid condition that wasn't treated. I have anxiety so this letter freaked me out because no doctor had told me that I had a thyroid condition. I found out during the week of thanksgiving so the office was closed for three days and I had to wait to call to find out what was going on. I finally got to call and it goes to voicemail. The next day that evening the insurance department called me back and told me it was and error and that I'm not the first person this has happened to. Apparently my thyroid levels are in the normal range but at the high end of it and doesn't need to be treated right now. She said she was going to resend my information. Does this mean I have to wait another 2 to 4 weeks to find out anything? I am lost.
 
Hi Looneyt. Dealing with insurance requirements definitely doesn't help the anxiety levels! I'm sorry you are going through this. Unfortunately, I don't have an answer to your question. I am guessing yes, only because most insurance companies process the requests in the order received and don't typically look through them to see if they are a second request or third. Hopefully it will go a little faster this time since they will have the previous rejection on file and know what areas they specifically need to look into for the approval this go around. Keep us updated on what they say. Sending you nothing but positive thoughts and hopes!
 
Hi Looneyt.

Ugh, insurance... It couldn't hurt to stay on top of everyone. Call you doctor's office tomorrow to ask if they've resent the paperwork. Then call your insurance company to be sure they received it and ask what else they need and how long before you should call them back for an answer. Keep on these guys, every day if you need to until you have your approval.

Good luck and please keep us posted! :)
 
Looneyt said:
Well today I have received a letter in the mail from my insurance saying that I can appeal there decision to deny paying for my wls. They have gave me an appeal date. I don't know if it will make a difference to appeal it.
I don't know how an appeal really works.
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It should definitely make a difference to appeal. From what I've read, some insurance companies automatically deny the surgery at first, assuming people won't appeal. So please do! Gather all the information Diane mentioned. If you need help, see your primary doctor, he/she should be able to help! Good luck!
 
I got a call today from the weightloss center. She said they are resending my documents showing I don't have a thyroid condition that it's in the high end of the normal range that I don't need it treated at the moment. She said everything should be good now. Hopefully that means I'll eventually get a call about having surgery.
 
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