Help! My Insurance Claim Has Been Denied!
You’ve spent months planning for your surgical procedure, scouring over your insurance policy and attending weight loss seminars. You may have even browsed for your new post-surgical wardrobe. The excitement is palpable! The only thing standing between you and surgery is your insurance company and low and behold, your pre-approval, or claim, is denied.
Every insurance company and each plan has a different set of qualification criteria for covering a bariatric procedure. That means that it is possible for your insurance company to deny an application. Denials can be a result of one, or several, factors that can include clerical errors by the insurance company, errors or omissions on your part, missing documentation, or you may indeed not qualify for bariatric surgery. If you believe your denial was in error, don’t worry and don’t panic. Every insurance company offers a comprehensive appeals process that will allow you to resubmit your application.
The first and most important step in appealing a denial is to request the reasons for denial in writing. This allows you to see exactly why the insurance company has denied your claim and gives you the opportunity to correct the issues they stipulate.
Secondly, work with your primary physician and bariatric surgeon to make sure that the resubmitted application is complete and addresses all the problems in the denial.
Unfortunately the appeals process is likely to be as cumbersome as the original application process, but patience and good organization will pay off in the end. The key to fighting a denial is to learn as much as you can about the reasons behind it and then employ the resources around you to overturn it.
Remember to be persistent. While a peer review with your insurance company can sometimes overturn a denial, the best course of action is to be persistent. If you believe that the denial was made in error, make every effort to contact the appropriate parties at your insurance company and plead your case with consistency and confidence.
Good luck and keep your eye on the ultimate goal.