Repost from Cali boards: DENIED :(

Hey all,

I posted on the Cali boards, but I also wanted to see what the successful RNYers might have to share on this. I've got an insurance denial that's a bit different than most and it has me stumped....

Any experience you guys might have would be helpful. Support, also, would be a major boost =)

Thanks,
Somayeh

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Hey all.

I've been around the boards for a while, but I haven't been posting much the last couple of years. Mostly I wanted to soak up what the losers on the bench have to teach, and partly because I didn't really have much news beyond "still struggling with the weight.." Last month, I got everything together and with the help of a lovely doctor here in Maastricht, Netherlands (I'm on a study abroad program), requested authorization for RNY from my health insurance through my university.  

Today, they called to say they denied me because I am on study abroad for my final year & did not show a need for urgency for the procedure. They don't claim it's not medically necessary, but deny me, saying I should just wait until I "get home." I won't actually be "going home" as it's my senior year and I plan to attend grad school in Europe.

Ah well. I could try to fight it, but I'm not sure how to fight this kind of denial. Instead, I'm reading up on a clinical trial in the area for a new procedure (restrictive only, no malabsorbative properties). I'm not giving up! I'm just being flexible. Especially if it could be free! =D


Could use your support and/or advise, especially if anyone else has come across this "it's not urgent enough" business before.

Thanks!
Somayeh

Are you asking them to pay for surgery out of the country?  And they want you to wait until you can have it done by someone "in network" or something like that?  If that's the case, I guess I would call them and ask what sort of documentation they need to see that it is urgent and you can't wait.  Maybe something like a letter from one or more doctors stating that your blood pressure is dangerously high and isn't responding to medication and you need surgery so that it can be lowered ASAP so you don't have a stroke?  Supposing you have high blood pressure.  But something like that.  Explaining why you need surgery now and not in seven or eight months.

If I didn't understand the issue, sorry.  It's not a denial I've ever heard of before, either.

 Hi Kelliy,

Thanks very much for the suggestion. I'm blessed(/cursed =D) with almost perfect blood pressure, but there might be a route available via obstructive sleep apnea. I'll see if I can get a sleep study done out here & if it's severe enough to warrant an immediate intervention.

Thanks!
Somayeh