Thank You - You've Been Denied! - Page 3 - ThinnerTimes

Raingirl33 · 11-21-2006, 09:57 PM

I'm sorry to hear about the crap they are putting you thru , just keep fighting them . I admire your attitude ~ Have a great time at Disneyland~
Happy Thanksgiving to you and your family .
Keep us posted

rainrain · 11-22-2006, 08:09 AM

Pat,
Please have a great day with no worries.
The timing in life is always difficult to accept, but since we have no choice, I love the way your handling it.
Have a chestnut for me!
Rain

Baron Patrick · 11-22-2006, 09:00 AM

Thank you all from the bottom of my heart! I get such a warm feeling of gratitude from all of you, and your friendship.

No, there really isn't anything you can do for me other than what you have been doing all this time - giving me your support, patience, friendship, and accepting me for who I am. I am blessed 100 times over, having the privilege of knowing you.

I can only have a "good" attitude over all this, getting mad won't change things, and is a waste of energy. I figure it this way, I know I'll have the surgery, and will do what's necessary to get the approval. There's a statement Winston Chruchill made (paraphrased) before Parliment during World War II that I truly believe in -

"Never Quit! Never, Never Quit!

If I have to, I'll go to my doctor for every little thing that can even be remotely related to my weight. I'll make sure I spend so much of the HMO's time and money with referrals and such they'll approve me just to get rid of me!

Again, thanks friends -

Peace and Blessings

LyndasRoom · 11-22-2006, 10:21 AM

Patrick,
My dr put me through hoops before she would even start my 6 month supervised "diet". Basically, she wanted my bp stabilized, approx 3 visits...then my annual exam...3 visits, including the mamo and the labs, then finally she said, ok, we can start your 6 month plan...by then I was so entrenched in going in and trying to straighten out things, the weight thing was almost an aside. She just asked how I was doing (I didn't lose any weight to speak of), if I was trying to exercise, blah blah...Like you, I remained calm, keeping my eye on the prize. I knew in my heart this was right...I didn't know what my insurance co would do. I wish you a wonderful Thanksgiving, a great time at Disneyland, and above all calm, knowing that time is your friend.

Starla · 11-22-2006, 07:40 PM

Hi All, Happy Thanksgiving!!!! I too went through all that crap with my HMO. Wanted to make me go through a 1 year supervised diet

I just kept filing the papers and with my second denial I was able to send out for the Independent Review with the State (Calif) I had my answer within weeks...APPROVED!!!!! My HMO had 5 business days to get me on the road to sugery, they could not appeal. Shame on the HMO's and their denials, why cant they see in the long run it will save them money as we get healthy. Hang in there and keep having your Doc file the paperwork til you get your denial again, then file with State. Good Luck to you

KnighTron · 11-25-2006, 08:41 AM

Why didnt you just start your visits with your pcp? I have cigna and they require the same 6 month vigil. Instead of arguing with them I started my visits. When I completed the visits they approved me in 2 days....no fuss, no muss. Why do you want fight? Just comply.

Ann8615 · 11-25-2006, 11:44 AM

Bummer. Every time I see you've posted I get so excited that maybe it'll be the post we've all been waiting for - that you have a surgery date! When I went to my PCP to ask for the WLS referral, he told me he would probably have to document my efforts. Basically, all he did was ask me to provide a list of dieting efforts with approximate dates & results. When the ins. company called to tell me I wouldn't get a consult, I told them that I had tried everything, and I had proof for the past 10 years (Meridia & Phen-Fen prescription receipts, Jenny Craig receipts, WW food diaries, gym membership receipts, etc.). If that wasn't good enough for them, then they needed to rethink their rules! 2 hours later they approved the consult - I was told that once they approve the consult, you are 99% sure the surgery will be approved. This is Blue Shield of CA.

Once you go through the grievance process, and exhaust all options, if you still don't get approved, can you change ins. co.'s?
Good luck, we are still rooting for you!
ann

Baron Patrick · 11-25-2006, 03:07 PM

Quote:

Originally Posted by KnighTron

Why didnt you just start your visits with your pcp? I have cigna and they require the same 6 month vigil. Instead of arguing with them I started my visits. When I completed the visits they approved me in 2 days....no fuss, no muss. Why do you want fight? Just comply.

I talked to Cigna, and I talked to my doctor who said Weight Watchers is acceptable, AND I talked to my surgeon's office who has experience dealing with HMO's.

As for "complying", I've done everything Cigna has asked. I've ensured all paperwork has been submitted as requested, and all required tests and more have been completed. Most of all, I've been patient, everyone on this forum who knows me, understands how patient I have been.

My question to you is, why would I NOT comply? I'm not looking for a lawsuit, all I want is the insurance company to provide what they say they will. Is that to much to ask? My doctor and surgeon also wrote a letter explaining this is medically necessary, and why. My HMO has been draging their feet, and coming up with new and additional requirements. All of which I HAVE COMPLIED.

By the way, according to the California State Department of Managed Health, it is not a requirement of the state to have the "six month" diet. In other words, the HMO can not force this on the patient.

Complience? I talked to the state Managed Health to file a grievance, and was told I first need to file one with Cigna first. This process takes 30 days. If the HMO once again denies me, I can, and will, go to the state, who will then deal with the issue. By the way, this will take an additional thirty days.

Duckie · 11-25-2006, 04:37 PM

Quote:

Originally Posted by KnighTron

Why didnt you just start your visits with your pcp? I have cigna and they require the same 6 month vigil. Instead of arguing with them I started my visits. When I completed the visits they approved me in 2 days....no fuss, no muss. Why do you want fight? Just comply.

Until you know what someone has been going through you may want to think before you type. I found this condescending.