Phebius

W...I was originally denied because my insurance company said that I didn't meet the criteria. Being obese should be enough, but they don't see it that way. I'm not sure what your medical issues are or if you even have any co-morbidities. I did not have one co-morbidity except a BMI in the 40's I believe. I sent a letter appealing and threw their weight "guidelines" back in their face. They definitely took a second look and I was very lucky to get a representative from my insurance company to really review the case. I'm not sure what stage you are in as far as the paper trail goes, but the representative did ask if I had been on any "supervised" diet plans. I told her to check my insurance history and I'm sure they would find the nutritionist referral I was given and that I had also been on Jenny Craig for more than a year. She did ask for those records from Jenny Craig because she said they would help make my point, and fortunately my counselor at Jenny Craig was great. They printed out all the items I had purchased, how much money I had spent, and then she handed over my file so I could copy it and then return it. I understand that your file has been "misplaced", but it will definitely help if they can locate it, especially if you don't have any co-morbidities. I sent a copy of my file to the insurance company and I got approved.

I hope I haven't bummed you out too much, I'm just giving you the facts in my case. I do have a suggestion though. If the director is willing to write a letter about you being part of their program, maybe he/she and yourself could kind of recreate your history in the program, your progress, and how much money you have spent, and maybe even have it notarized so that the insurance company doesn't think you "made up" the whole thing. They don't have any of your records in their computer? Maybe they could print out some sort of account ledger showing how much money you spent and when. That might at least convey a time line for them, proving you were following the program you were in.

It was a long process for me even though things seem to be moving along quite quickly now. From my second request for just the consultation to actually having the surgery took almost a year. It can be overwhelming and seem like a never ending process, but it's the best thing I ever did for myself. Well, I'm sorry if I've gone on too long, and I hope this helps you in some way. I wish you the best of luck on getting it through your insurance company and getting approved for surgery.

Pamela
Open 08/26/03
272/165/120