Officially Denied....Completly Depressed

Thread Starter  

I called BC/BS Alliance Select and was told that I was denied because my BMI wasn't High Enough I've yo-yoed between 37-40 for the past two years and that my co-morbidities aren't enough I have gerd, asthma, migraines, joint pain and depression. Geez I don't know if that is enough i mean my weight basically dictates what I can do in my life. This is so messed up. I'm of course appealling and resubmitting my Insurance lady at the surgeons office is out until Monday so I called and left a message that says I needed to talk to her called my PCP and asked him to write a letter of medical necessity and to please list all the stuff I've tried and failed at, all my co-morbities and how this is going to help me be healthier yadda yadda yadda. Am I missing anything that I should be doing? I'm a college student so self-pay is out of the question. I really think I need this surgery I wouldn't have worked towards this for over a year if it was just gonna be a quick fix I'm ready to start a healthier life for myself why can't my insurance company help me out How much money would they save if I didn't have to go to the doctor as often or get Rx's all the time....

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~Xgrl~
Mailed Paperwork to INS 7/22 Denied 8/6 Denied Again 9/5 Sleep Study 8/30 Yeah Apnea! Resubmitting soon!!!
Dr. Glascock 254/252/???/140
"I suddenly realized that unless some thing changed soon... I was going to live a life where my major relationship...was with a bottle of wine... and I'd finally die fat and alone...and be found three weeks later, halfeaten by wild dogs."

Don't give up - I ended up being a "self-pay" and went to Tijunana. I was denied by BC/BS as well. I would absolutely go to Mexico and have this procedure done again if I had too. I am happy with it and was very happy with the hospital and doctor. Don't give up!!!!

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Banded 4/19/08: Tijuana, MX at Hospital Angeles, Dr. Corvala; scheduled through "World Med Assist". Call them and give them my name as your referral, they are great!
1st Fill: 5/31/08 - 1.5cc - 27 lbs. lost so far....2nd Fill: 7/19/08 - 1/2cc - 37 lbs. lost as of today!...3rd Fill: 9/13/08 - removed .4cc - 43 lbs. lost as of today. 12/6/08 - added 1cc at my fill appt. No weight loss to report today.

get your doctor so guarantee that you will qualify, if that means stuffing a couple extra weights in your pockets when they weigh you, so be it. High blood pressure, physical therapy for back, knee, spine problems, etc......GERD? make it GERD with severe reflux, esophageal strictures from acid scarring, etc,,,,,,,,, getting the messag? enhance the problems. Some doctors know how to ensure an approval better than others.

Don't give up because a lot of us have been denied by insurance. I am a self pay and went to have mine done by Dr. Kelly in Mexico too. His site is on my signature and I would do it again in a second because it was the best thing I ever did. My girlfriend that had her band done by a DR. at UCI Medical lost her insurance and he wanted to charge her a Thousand dollars per fill!!! WHAT A RIP OFF!! It is a needle and some saline maybe costs them 15.00. So she started going to my Dr. that charges 170.00 a fill and has received way better results and is now down 100 pounds. She couldn't be happier with her new body!
So don't give up. I had to get a personal loan and pay it off with monthly payments for the next two years but was worth every penny. I now have overeating under control and it is like a weight lifted off your shoulders that you now have the power to only eat small portions and be okay with it. When you reach a good restriction with your band you have to change what and how much you eat. I don't obsess on food anymore and it took awhile for my head to get to that point but I feel powerful now!!! Don't give up because you are worth it and if it is meant to be it will happen for you honey!!!!!!!!!!!!
Good luck

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Banded on Nov 24, 2006 :nervous
Started at 250
Current at 197
04/14/07 2nd fill 4.0cc
09/22/07 3rd fill 4.5cc
03/08/08 unfil 2.5/ at 2cc
4/26/08 fill 1.0/3.5 and sweet spot!! :)
Goal is 170-160
Banded by Dr. Ramos Kelly in Mexico www.obesitybusters.com

Thread Starter  

Thank you guys so much for being so supportive I plan to appeal it just sucks having to wait for something I've been working on what seems like forever although I know there are people out there that have been fighting the insurance company for alot longer I'm looking into leg weights to get my BMI back up to atleast 40 it sucks that I tried so hard to get my weight down and I'm now trying to get it up so I can get some help to get it down AND STAY OFF lol oh well Thanks so much for your support Hopefully I'll get my date soon!!!

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~Xgrl~
Mailed Paperwork to INS 7/22 Denied 8/6 Denied Again 9/5 Sleep Study 8/30 Yeah Apnea! Resubmitting soon!!!
Dr. Glascock 254/252/???/140
"I suddenly realized that unless some thing changed soon... I was going to live a life where my major relationship...was with a bottle of wine... and I'd finally die fat and alone...and be found three weeks later, halfeaten by wild dogs."

also state to your doctor that you feel like your gasping for air while you sleep so you stay awake because you fear you may die in your sleep.

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I'm so sorry you've been denied. But like the others have encouraged I'd appeal. And please do talk to the dr's. I'm sure they will help.

Teri

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Terilynn (single mom to three great boys... twins plus 1).... 3.2 cc's in my 10 cc LAP-BAND^® AP (fills 11/6/08 ; 11/20/08; and 12/17/08)
H270/S240/C224/G170
Surgery date... September 16, 2008

I was denied by BCBS in the fall of 2005 at the time my BMI was 49 and I was insulin resistant with PCOS only. I have since gained weight with a BMI of 53 as of May 2008 and become a full type-II diabetic with high blood pressure on medication and joint pain. I was approved in 5 business days after the paperwork was sent through to BCBS. The only difference this time besides the increased BMI/weight and hypertension was the 12 month physician monitored diet/weight loss plan that went with it. In 2005 BCBS requested a 6month plan, but my Doctor said let's make it a year so that there is no excuse from them. It worked and over the past year I tried 4 different diet plans, weight watchers, nutrisystem, Jenny Craig and FDA low fat, low calorie diet - I gain 18lbs during these 12 months.

Don't give up keep trying - they have a set rule that they follow,
6 month physician supervised diet,
at least 2 comorbidities
BMI over 40 -
they simply will not approve if these 3 things are not met unless there is a really great medical risk.

Don't give up!

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Lynn ;-)

Approved July 18 th,
Surgery date - Sept. 02, 2008-
Dr. Shayani - Chicago, IL

Did you have a sleep study? If not, GET ONE! Chances are you have some degree of sleep apnea if you are over weight.

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Humana (doesn't cover) and Tricare Insurance
Tricare denied! Appealed and reversed!
Surgery September 30th
First fill Nov 5th 1cc (total of 4 cc in band) Highest=233/preop=220/present=178

Thread Starter  

ARGH, I got denied again!!!! I'm so upset I just wanna freak out on the insurance people although I know it'll get me know where? something along the lines of ARE YOU FREAKIN KIDDING ME!?!?!? You denied me the first time because you said that my BMI wasn't documented and this time you denied me for "unknown" reasons according to the guy on the phone but apparently it'll be on some letter I'm getting in the mail....prob will say not medically necessary...because that is really specific and helps me try and convince you in the appeals process that I need this surgery! stupid insurance!?!?

__________________
~Xgrl~
Mailed Paperwork to INS 7/22 Denied 8/6 Denied Again 9/5 Sleep Study 8/30 Yeah Apnea! Resubmitting soon!!!
Dr. Glascock 254/252/???/140
"I suddenly realized that unless some thing changed soon... I was going to live a life where my major relationship...was with a bottle of wine... and I'd finally die fat and alone...and be found three weeks later, halfeaten by wild dogs."

There are several loans available online for this type of thing, and that's how I am able to finance my band because insurance wouldn't have covered it for me either. It's do-able, it's just going to cost a little more now. Don't get so discouraged! You will find a way, I'm sure. Good luck, and keep us updated!

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Surgery 11/5/08 with Dr. Kirshenbaum in Denver, CO. www.lapbandrockies.com