An insurance rant - United States

I have been on this journey since March. The very first step my surgical team had me do was to call my insurance company to see if certain procedure codes were covered by my policy. I was told yes, and obtained the rep name and phone convo reference number, this began the process. Fast forward 6 months to now - I have spent over $2k out of pocket on pre-op appointments for this procedure, I have been cleared by a hematologist and a cardiologist, the psyche eval, all nutrition appointments and monitored dietician appointments have been kept, attended, verified, and signed off on. On Friday Aug 29, my surgical team submitted to the insurance for Authorization - it was DENIED, less than 24 hours after it was submitted, a process my surgical team said could take up to 30 business days.

Looking at the Denial for authorization, it says these procedure is not covered by my policy - which is in direct opposition to what the initial rep advised me. I don't really know what to do with that conflicting information. When I was scrutinizing the denial letter further, it listed an incorrect procedure code (showed a bypass, not a sleeve) AND it only listed the diagnosis of Obesity, and none of the comorbidities I have (BMI of 44, hypertension, OSA, asthma etc..) .What I have done now is draft a letter to my surgical team asking them to resubmit the pre-authorization request, with the correct procedure code and a request to list the comorbidities, not just the code for obesity. Did you know there are several different obesity codes? Today I learned.

This has NOT been an easy process, I feel like I have had to fight for this every step of the way. I am not giving up yet, but this is a message to say that if you don't advocate for yourself, you will be stepped on and kicked over by the American insurance machine. I will post updates as they become available.