I got denied

Tropicana · 12-10-2005, 02:09 AM

Who was I kidding? My BMi wasn't high enough and I had no comorbidities. Oh well. :(

Dody · 12-10-2005, 05:49 AM

Quote:

Originally Posted by Tropicana

Who was I kidding? My BMi wasn't high enough and I had no comorbidities. Oh well. :(

Don't be so positive you don't have co-morbitity factors. I didn't think I did either till I had a sleep study test and found out I had sleep apnea. Have you tried every avenue you can think of. Did you have a sleep study test? Cholesterol testing? BP only controlled with medication? I didn't think that I had them all covered but I do, and most overweight people do....so think again what you might have left out of your testing.

My BMI wasn't high enough either, but the other things justified it. At 5'9" and 257 lbs. I was just below the required BMI because of my height. Don't give up till you have tried everything.

Maggie63 · 12-10-2005, 08:45 AM

sorry tropicana. i self payed. it is difficult, but after my insurance denied me, i paid myself and i am going to fight them. they told me a month or so ago i was covered, than called me later to say i am not. they would be happy to pay for gastric bypass, but not the band. makes no sense!!

imalene · 12-10-2005, 09:55 AM

Is your cholesterol at a normal point, do you not have any joint or back pain? Maybe you just don't even report these things that almost always accompany obesity - because they are just "normal" for you.
Now that I've said that - I have to tell you that I didn't even try insurance because personally I just wasn't up for the fight. Also my co-pay would have cost about as much as what I'm going to be paying in Mex. My BMI is 34 - and I am going to self pay ($8950) in Mexico with Dr. Kuri in Jan. He's said to be the best and he teaches U.S. doctors.
Take care!
Patti

NJChick · 12-10-2005, 10:03 AM

I'm so sorry :(

Tropicana · 12-10-2005, 10:09 AM

I reported everything I could think of but it didn't seem to sway them. I am getting a copy of my insurance benefits mailed to me from HR and really go through it.

I have 6 months of failed diet (WW) but no doctor's verification. I just went to the meetings and have the little booklet they fill out.

I haven't gotten any sleep tests or cholesterol checked but I probably don't have high cholesterol or diabetes since I don't have a family history of that going back 3 generations. The sleep tests might come out in my favor, however. So I will schedule that.

Self pay is not an option for me.

One thought, does the insurance company frown on the idea of switching doctors? I really don't have much confidence in the paperwork my first doctor sent. If I go to a different LAP-BAND^® doctor, you think I will have more of a chance or do I have to stick with the same doctor for a second appeal? How many times can you appeal?

HarleyNana · 12-10-2005, 10:27 AM

Sorry, I don't have any suggestions, my ins co didn't off any WLS coverage, so like so many others, I was self pay.

NJChick · 12-10-2005, 10:30 AM

Did your doctor do complete bloodwork on you ? Only because when they do the bloodwork they automatically do a cholesterol check and you might be closer to diabetes than you think. When I went for my blood work they took 15 vials (just to give you a picture).

I would switch doctors if your not comfortable. At this point what do you have to lose. Find one that will work with you. Check out the Insurance board here, you might find your questions about that answered.

Good Luck !!!

piercedqt78 · 12-10-2005, 12:28 PM

With most insurance companies, you have the original submission and then 2 appeals, sometimes 3. When that is exhausted you can then take it to an outside review, at the insurance companies expense. I was ready to go that route and I got my husbands Union involved, also the employer. The insurance company sang a different tune when the Union called and questioned why I was not being covered. Some co-morbidies that most people don't think about are irregular periods, migraines, joint pain, reflux, shortness of breath. I fought a major company and won, if you have any questions feel free to pm me or send me an email. ~Mandy

Glo · 12-10-2005, 05:45 PM

Trop, it's a blessing that you don't have comorbidities. Now what is your plan, will you try a nutrition program and exercise?

Tropicana · 12-10-2005, 06:42 PM

Quote:

Originally Posted by NJChick

Did your doctor do complete bloodwork on you ? Only because when they do the bloodwork they automatically do a cholesterol check and you might be closer to diabetes than you think. When I went for my blood work they took 15 vials (just to give you a picture).

I would switch doctors if your not comfortable. At this point what do you have to lose. Find one that will work with you. Check out the Insurance board here, you might find your questions about that answered.

Good Luck !!!

Hmmm........

Tropicana · 12-10-2005, 06:43 PM

Quote:

Originally Posted by Glo

Trop, it's a blessing that you don't have comorbidities. Now what is your plan, will you try a nutrition program and exercise?

Yup yup, back to Weight Watchers.

Tropicana · 12-10-2005, 06:44 PM

Quote:

Originally Posted by piercedqt78

With most insurance companies, you have the original submission and then 2 appeals, sometimes 3.

I had no idea the process was that intensive. How long did it take from your very first visit to when you were approved?

Glo · 12-10-2005, 09:26 PM

for me 6 months Trop.

Tropicana · 12-10-2005, 09:38 PM

Wow. Okay, well I will continue with my healthy lifestyle and still go and see my LAP-BAND^® doctor. I am still seriously thinking about getting a new physician though.

Quote:

Originally Posted by Glo

for me 6 months Trop.