once again...DENIED!!!!! - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

tx mom · 07-10-2008, 11:49 AM

after spending over 3 hours on the phone with my insurance company on tuesday and another 1 1/2 today i have once again been told that i am denied. aughhhhhhh!!!!! i hate my insurance company. so today after talking to numerous people and being told i was denied and that the surgery isn't even on my policy i finally got someone that said that they haven't been sending my appeal to the right department. i really don't know what to believe anymore. i am about to go postal on my insurance company. uhc sucks!!!!

thanks for letting me vent.

Withacy · 07-10-2008, 12:21 PM

Since most insurance is purchased in packages with ala cart add ons by employers (or in some cases, individuals), you might try your personnel department. They should know what they purchased. Plus, in the case of extremely large employers, the insurance company merely provides the provider network and processes the claims - the employer assumes all risk - and in THOSE cases, employers have a whole lot of latitude in deciding coverage issues.

tx mom · 07-10-2008, 01:57 PM

the deal is i know it is covered. when i received my denial letter it said that according to my plan i needed to show proof of being obese for at least 5 years and have a bmi of at least 40. so we sent in the 5 year proof and had already been cleared on the bmi. but my insurance isn't looking at the new information. at first they said that it was just a duplication of the first round, that is impossible because the first round didn't show the 5 year proof. tuesday the lady said that she would put a rush on it because apparently they weren't looking at the new info. today a different lady said that apparently it was being sent to the wrong department . i am just so frustrated with the whole thing

Withacy · 07-11-2008, 04:35 AM

I'm sorry.

I guess I spent too many years on the other side of this, and never really had the problems with getting things approved before. I can see how frusting this is - and I'm really sorry you haven't been able to find someone at your insurance company to take ownership of this and marshall it through. I know that would make a great deal of difference - especially with regards to your understandable frustration.

Sue0609 · 07-11-2008, 10:20 AM

Did you speak to them today? I have UHC also and was approved pretty quickly (I don't have the 5 yr. requirement, just the BMI). There was some confusion, but getting a friendly person on the phone helped. Try walking them through what they have and explaining how it is different from what was there before. Ask if she can make explanatory notes and expedite it.