Denied on May 9th - ThinnerTimes

Native2u · 05-12-2008, 03:01 PM

Happy Mother's Day to me!!

I just found out that I was denied. I called my insurance company and they couldn't tell me why..so, I'm waiting for Dr. Jawad's office to call me and tell me what I have to do to get to YES! I have done everything that I was requested to do, by my insurance company....so, WTF. They claim that its not medically necessary. I currently have HB....I guess I need to have Diabetes too? Well, I have news for them....its coming.

Venting just a little......cause I feel like crying!!

AmityA · 05-12-2008, 03:14 PM

I was denied too on my first try. My clinic did a peer-to-peer review with the insurance dr who denied me and then got approved. FIGHT IT! Keep on fighting it. They want to see how much you want this!

soon2bthin · 05-12-2008, 03:22 PM

Fight for yourself!!!! Make the insurance tell you why you are denied. They are there for you. Your doc will most likely step up to bat for you as well. Don't take no for an answer you can appeal. Good luck.

BabyNicole · 05-12-2008, 03:37 PM

I'm so sorry.

Native2u · 05-12-2008, 03:58 PM

Quote:

Originally Posted by soon2bthin

Fight for yourself!!!! Make the insurance tell you why you are denied. They are there for you. Your doc will most likely step up to bat for you as well. Don't take no for an answer you can appeal. Good luck.

I did ask why.....many times and she said that the only thing in the "notes" was...not medically necessary. Well, I really need to know what that means. She did however take me to a website for Aetna that tells me what I have to do to qualify for the surgery...I told her, all of this is done & turned in! I did ask her if I have the right to appeal this....she said, yes!

I have called Dr. Jawad's office and left a message for the nurse or someone to call me back tomorrow.....maybe they can better enlighten me as to why I was denied.

Native2u · 05-12-2008, 03:59 PM

Quote:

Originally Posted by AmityA

I was denied too on my first try. My clinic did a peer-to-peer review with the insurance dr who denied me and then got approved. FIGHT IT! Keep on fighting it. They want to see how much you want this!

Trust me....I'm ready for this fight! I'm not going to give up that quickly.

I just need to know the next step....so that I can get to YES/APPROVED!

BabyNicole · 05-12-2008, 04:22 PM

Quote:

Originally Posted by Native2u

I did ask why.....many times and she said that the only thing in the "notes" was...not medically necessary. Well, I really need to know what that means. She did however take me to a website for Aetna that tells me what I have to do to qualify for the surgery...I told her, all of this is done & turned in! I did ask her if I have the right to appeal this....she said, yes!

I have called Dr. Jawad's office and left a message for the nurse or someone to call me back tomorrow.....maybe they can better enlighten me as to why I was denied.

At my surgeon's office they do ALL the appealing and have lawyers for free to help you so you don't have to do anything...except get more tests or whatever. You should see if they have that at your office.

fisher1000 · 05-12-2008, 04:31 PM

Yeah, Keep fighting...and while you do, hum along to Amy Winehouse:

"Well Sometimes I Go Out, By Myself, And I Look Across The Water.

And I Think Of All The Things, Of What You're Doing, And in my head I Paint A Picture.

Since I've Come Home, Well My Body's Been A Mess, And I Miss Your ginger Hair, And The Way You Like To Dress.

Oh Won't You Come On Over, Stop Making A Fool Out Of Me, Why Dont You Come On Over, Valerie."

When I see your posts...I sing this song in my head!

Everything's gonna work out--just keep up the fight!

-Mike

Native2u · 05-12-2008, 06:31 PM

Quote:

Originally Posted by BabyNicole

At my surgeon's office they do ALL the appealing and have lawyers for free to help you so you don't have to do anything...except get more tests or whatever. You should see if they have that at your office.

GREAT idea.....I'll be asking them.

Thanks!

Native2u · 05-12-2008, 06:33 PM

Quote:

Originally Posted by fisher1000

Yeah, Keep fighting...and while you do, hum along to Amy Winehouse:

"Well Sometimes I Go Out, By Myself, And I Look Across The Water.

And I Think Of All The Things, Of What You're Doing, And in my head I Paint A Picture.

Since I've Come Home, Well My Body's Been A Mess, And I Miss Your ginger Hair, And The Way You Like To Dress.

Oh Won't You Come On Over, Stop Making A Fool Out Of Me, Why Dont You Come On Over, Valerie."

When I see your posts...I sing this song in my head!

Everything's gonna work out--just keep up the fight!

-Mike

Thank you Mike!

My hubby was like......what do "WE" need to do to get to "yes". Hey, at least that he is going/willing to fight with & for me.