Devastated!

jillrn · 11-15-2005, 08:06 AM

I have done my seminair my 18 mo supervised diet and all the other hoops. My insurance I called 5 times to verify coverage and read it in my handbook. I had my pre op with the dr and they told me they were sending stuff in that day and that was the 14th I think. I called my insurance a week later they didnt have I called Dr they said oh we are sending it today. I called a week later again insurance didnt have it. SO I called the Dr they said we sent it today-- I was getting a little frustrated but I thought "just be patient" So I called yesterday to find out if I am approved and they said I am denied that dh work put an exclusion on it as of NOV 1 they day they received my paper work!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! I am going to appeal but I know it wont do any good I dont know who to be mad at the DR office or my dh work! I was so helpful that this was the tool to help me get healthy and be around to raise my kids-- I cant believe I was one day too late!!!!!!!!!! Anyone else have approval even though their was exclusions. I had 4 dr's write in saying I need this surgery. I think I will start a web site for self pays and we will all send 5 people $5. for the surg-- like a pyramid scam! Coarse you would have to have 3000 people do it for 5 people to get the surgery!!! Any ideas-- I tried everything and I cant loose weight! Jill

PS I know I saw an appeal letter on some web site it was very good any idea where it is?? Jill

Anwyn · 11-15-2005, 08:22 AM

I would go straight to your husband's work and talk to HR. Explain the situation to them. Because you were already preparing for the surgery they may allow insurance to cover it. I think you have an excellent case for an appeal with the insurance company - don't give up now!

NJChick · 11-15-2005, 12:38 PM

Oh boy that does suck. I agree with Anne, go to hubby's HR dept and start there. Uhhh i could scream for you. I'm very sorry.

Hugs, Eileen

tomorrowsdream · 11-15-2005, 02:16 PM

The problems with insurance are the "suckiest" part of getting this surgery done. We just have to hang in there and be strong. Either wait for our insurance to cover it, as I'm doing with Medicare, or get up and fight those that have an exclusion. I laugh at the ones that will say OK to gastric bypass but no to the Lap Band. Do they even realize how dangerous one is as compared to the other. I say if you want this keep on fighting to change what is unfair. It burns me up. I too went through a lot of preparation, but now if Medicare covers it in Jan. I have all of my work behind me. The sleep apnea test which was positive is done and I'll be going on C-pap tomorrow; I'm having my psych eval in Dec. and I have an EKG and electrocardiogram, plus letters from my cardiologist and my dr., plus a dietician's letter. I'm anxious to see what other roadblocks they can throw in my way.

The only thing I can say is that if half of these women here had taken NO for an answer none of them would be banded today. The road is long and hard and takes perseverence. Good luck.

Firecallie · 11-15-2005, 07:11 PM

I too think you have an excellent case for an appeal, stay positive!