Approaching your Insurance after a Bariatric Surgery Denial

Your doctor and you have decided that it is medically necessary, medically beneficial, and/or crucial to your mortality to get you out of bariatric supplies through having bariatric/obesity surgery. 

You collect the proper paperwork and submit it for your insurance company to review and BAM!  They deny you faster than you can look at beach vacations online.

What do you do now?  Do you give up and despair or are there alternatives?  According to CNN, you may have a few courses after your denial.

Firstly, ask your insurance company to review the paperwork and explain to you the denial.  It could have been that a wrong diagnosis code or a missed diagnosis code is all that stands between you and a healthy BMI.  And remember, with big insurance, it's easier to catch flies with honey than vinegar, so make sure to be courteous and get a file number for your call.  This makes things easier to trace later on should you have to call back and dig deeper.  Your insurance company should review the denied claim and get back to you within 30 days, but they could move sooner.  And while they are reviewing things, you need to collect some paperwork. 

It could be that your doctor did not submit all the proper medical paperwork.  Believe me, it happens all the time.  You will need copious amounts of papers, signed by your doctor, explaining why you are a candidate for bariatric surgery and how, in getting this surgery, you will save your insurance company money in the long run.  If an insurance company can see that you are an expensive patient to keep, they are more inclined to grant you what you need.  But you have to do it right.

So collect copies of your medical records, of your filled prescriptions for obesity-related symptoms, your logbooks if you are diabetic, your test results if you've had a stress test (for example), and anything else that could help your case.  Just because these tests and procedures are filed with your insurance doesn't mean that they have seen the results or seen the results in a comprehensive, conclusive fashion (all the test results all together).

Combine all of your paperwork with a statement of medical necessity and conclusion from your doctor.  And not just your primary doctor, but from all doctors you have seen about your bariatric-related medical issues.  Credible paperwork can go a long way.  And while it doesn't guarantee anything, it won't hurt.

But if your insurance company denies you twice, you have the right to bring your case up for private or independent review.  This will allow you to fully explore your case and its denials.  Then you can ask for further explanations of the denials and review process if you need to.  Remember, it's your life.  You can have better control of your life with your insurance if you take hold of the wheel and steer your own course.