Insurance denied!

Massage_lady
on 11/2/14 3:12 am

I would not consider myself a smoker. I was having about two a week with my husband as a way to relax with a drink. I usually mark "no" on surveys and whatnot, because it is so infrequent. So when they therapist doing my eval asked, I told her the truth. So now I am marked a smoker!?! I told the therapist I would quit because it was no big deal, and I did. I have been absolutely smoke free for three weeks! But because I told the therapist that, my insurance denied me. Now what? Is there a test they can do that proves I quit?

poet_kelly
on 11/2/14 3:38 am - OH

Your insurance has a policy that says you cannot be a smoker?  That's unusual.  Many surgeons won't operate until you quit but I think it's unusual for insurance companies to have that policy.

Anyway, I'd call your insurance company and ask how long you must be smoke free and if they require a nicotine test to prove it.  There is a blood test they can do.

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

Cicerogirl, The PhD
Version

on 11/2/14 3:59 am - OH

I doubt that smoking was the reason for denial unless your policy explicitly states that smokers are ineligible (which I have never heard of).  

What, exactly, did your denial letter say?

Lora

14 years out; 190 pounds lost, 165 pound loss maintained

You don't drown by falling in the water. You drown by staying there.

Sarahlicious
on 11/2/14 4:22 am - Portsmouth, OH

As mentioned, find out exactly why the insurance denied you, it should state the reason in the denial letter, it should also reference any policy guidelines they used to make the decision and you have the right to get a copy of those guidelines. Then time to appeal! http://www.obesityhelp.com/articles/7-tips-insurance-appeals

I have Lipedema and Lymphedema. I also have a passion for Obesity and Health Insurance Advocacy

Blog: born2lbfat.com Facebook: Born2lbFat Twitter: @born2lbfat

Massage_lady
on 11/2/14 4:49 am

The letter states "The plan participant is not a non-smoker. this service is defined as a not covered expense under the plan." MedCost

Annakay76
on 11/2/14 5:47 am

I have to take a nicotine test to get hired at my current job, it looks like a pregnancy test. My dr office said they would set up an appt to try to get approval if originally denied.

Bubbles314
on 11/2/14 6:07 am - Kalamazoo, MI
RNY on 10/06/14

"Do you smoke" was an important question from my Dr.  He gives his patients time to quit, but you need two nicotine tests clean before he will do surgery.  Everyone gets the test whether you smoke or not. (for those who do not tell the truth).  Dr said it usually takes smokers 6 months to quit if they are serious about WLS.  He will not operate on a smoker.

  

Hislady
on 11/2/14 7:25 am - Vancouver, WA

It almost sounds like they don't cover bariatric surgery the way it says it is a non covered service. Did you check with them before hand to see if they cover bariatric surgery or were you going by what your surgeons office may have told you? I too have never heard of an insurance company refusing surgery because of being a smoker.

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