Insurance Approval process?!?

Updated 4 days ago in Gastric Sleeve Support Groups
1 on March 13, 2020

So I’ve been trying to get my insurance to pay for my VSG surgery been through the whole process got all my clearances. Just for them to deny my claim 3 times. My first weigh in my bmi was only a 38 with no comorbidities. I have moderate sleep apnea which didn’t count in the insurance eyes they said my surgery was not a medical necessity. So my surgeon appealed the denials. This process is so frustrating and each time i get my hopes up from calling the insurance them telling me its approved to my doctors office saying no its been denied . Im so fed up and want to go to mexico but my partner isnt okay with that decision. They stress actually made me gain even more weight and no my bmi is a little over 40 so my doctor wants to try and appeal one last time with the new bmi. So as of now im waiting for them to get back to me the 4th time to let me know if its a go or no. I have United Health Community plan and i live in the state of Ny anyone esle have this constant battle with the insurance ? As of Dec 2019 i read that my insurance states that you quailfy for weightloss surgery if you have a bmi of 40 or if its 35-39 with a comorbidity im hoping gaining that extra weight helps me out this time around.

 
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Is the hospital saying that you do not qualify for surgery? Can you go to a different one? I have seen one doctor approve surgery and another refuse it before.

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