Hello

[Skinny Mini]

Greetings Everyone,
My first time to the site. I haven't had my surgery yet. I am having issues with my insurance company. They will not pre-authorize because they categorize bariatric surgery as "elective".

I was told that Diana and Larra could help. And, from what I have read tonight, this is an amazing place for support. I am looking forward to having you all on my journey with me

How do I get started?

Oh! and I am planning on getting the gastric sleeve.

 

[hilary1617]

Hi and welcome @Skinny Mini ! Tagging @Larra and @DianaCox . Best wishes!

 

[southernlady]

Welcome @Skinny Mini

As to how to get started...you need a copy of your Evidence Of Coverage (typically more than 100 pages long) and if it's thru an employer, you need to get it from Human Resources.

 

[Munchkin]

Another thing you can work on is getting a LOMN(Letter of Medical Necessity) from your doc and any other medical professionals you see. Here are a ton of examples. https://www.google.com/search?q=let...LQpfvWAhUV6WMKHWoYCZoQsAQIRg&biw=1920&bih=949

Once you have established surgery is a medical necessity for you, it is therefore no longer elective.

 

[DianaCox]

Elective is not a reason for denial. All surgery that isn't an emergency is "elective."

 

[Skinny Mini]

Elective is not a reason for denial. All surgery that isn't an emergency is "elective."

So I have the nearly 100 page document, I think its actually 63 but hey what's 37 pages . And thanks Munchkin, I passed all of my medical info off to the surgeon's office a couple of weeks ago. The insurance manager opened a case for me, but they are unresponsive. I will take a look at these and see how it compare.

Is it appropriate for me so submit a letter on my own? Or should I wait to see what happens with the case file?

I tried to argue Diana's point too. I was honest with everyone that I talked to. I was told that my BMI needed to be 40, bu t with co-morbidities it could be lower. Mine is 37 and I have 2 issues that qualify for the co-morbidities.

 

[Settledownnow]

Greetings! I deleted the rest of my post because it was on the wrong posting.