Denied again!!!! - ThinnerTimes

Native2u · 05-29-2008, 12:38 PM

I just got off the phone with my doctor's office and they told me that I was denied again due to NOT having HB for more than 2 years. I was diagnosed with HB Sept 2007. I guess that they want me to get bigger and bigger!! What the heck!! This is very upsetting!

Does anyone know of anyway that I can prove that I have been over weight of years now? My current BMI is: 41 w/HB My father has HB and diabetes and we have a HUGE family history of heart disease. What more do they want from me??

Godsblessedme · 05-29-2008, 12:40 PM

oh Valerie i'm so sorry i dont know other than keep appealing it! why are insurance companies so darn stupid

Native2u · 05-29-2008, 12:47 PM

Quote:

Originally Posted by Godsblessedme

why are insurance companies so darn stupid

YEAH!! I'm beginning to wonder if they have forgotten about something called.."preventative maintenance". I guess they want to fork out all of the medication and other doctor bills, etc....rather than let me have the surgery.

My plan is to appeal again. My doctor's office told me that they don't know what more they can do for me at this point, until I get the insurance company to approve me.

doxielover · 05-29-2008, 12:50 PM

Hi Valerie - I'm so sorry this **** is happening to you. The national standards are that bariatric surgery should be done with patients with a bmi of 40 or over with no co-mormids or 35-40 with two major co-morbids. My bmi is barely 40 and I have only had HBP for 6 months. I also have degenerative disk disease, but that is not considered a major co-morbid. What state are you in? I would call the state agency that oversees Health Insurance Companies and ask them how to proceed. In California that board is very active in overturning insurance companies and ruling in favor of the patient. Good Luck in this quest! You might want to look on the insurance board at obesityhelp.com and ask Gary how you should proceed. He is an attorney and very knowledgeable. April in Sacramento

Native2u · 05-29-2008, 12:56 PM

Quote:

Originally Posted by doxielover

Hi Valerie - I'm so sorry this **** is happening to you. The national standards are that bariatric surgery should be done with patients with a bmi of 40 or over with no co-mormids or 35-40 with two major co-morbids. My bmi is barely 40 and I have only had HBP for 6 months. I also have degenerative disk disease, but that is not considered a major co-morbid. What state are you in? I would call the state agency that oversees Health Insurance Companies and ask them how to proceed. In California that board is very active in overturning insurance companies and ruling in favor of the patient. Good Luck in this quest! You might want to look on the insurance board at obesityhelp.com and ask Gary how you should proceed. He is an attorney and very knowledgeable. April in Sacramento

I'm in Florida!

Thanks for the insight. I will do just that.

I know that I'm on the low end of the BMI, but, Sept 2008 will be 1 year of HB for me. I have never been a good pill taker and I do forgot, from time to time to take my HB medication. I know that is my fault.

I will ask Gary. I'm a member of that forum too.

Jeanie · 05-29-2008, 01:44 PM

I had to appeal twice before I was approved, and that was with a HIGH BMI and other issues. I know that my Doc helped me write the 2nd letter. You should ask your docs office to give you a copy of your medical history so you can send that in with your letter. That's what I did it went before the board and I was approved to go see Dr. C. Good luck to you!

SimplySamaria · 05-29-2008, 01:48 PM

I am so sorry you were denied, again! Keep fighting for what you want! You are worth the fight! Have your family Doctor also write a letter, and any other specialists you see. Call the insurance company and ask them what else it is that you need to do for approval. Or just find a lawyer.

snick1899 · 05-29-2008, 02:05 PM

I am so sorry they denied you! Keep us posted on what info you get from Gary! I would gather any and all records you can get your hands on, even if it seems insignificant. I got my old doctor's records from Ohio, I got my records from my orthopedic specialist from when I broke my knee (He said I couldn't run again until I dropped 50 lbs, so that limited the exercising I could do to lose weight), I recorded EVERY diet I had tried in the last 5 years, even the ones I only stuck with for a couple of weeks. I don't know what they used for consideration, but my surgeon said it helped! I know you have had a hard time getting ahold of your records, but maybe something that you never thought was relavent may have something in it that could haelp your case. I am keeping my fingers crossed and my tank filled! ;-)

SlimmerDreams · 05-29-2008, 02:14 PM

I'm so sorry you are going through this. I know exactly how you feel! I was denied 5 times before I finally got an approval 5/13/08. I finally have a surgery date of 6/26/08. I have been trying to get this done since 2004! It took FOREVER!!! I gave up on my primary doctor trying to get it approved and asked to get a referal to see a specialist. That is when it finally went through. That might be an option for you.

Hang in there, it will happen...

BabyNicole · 05-29-2008, 02:15 PM

I'm so sorry you were denied again.

I know that at my surgeon they have lawyers to help with your third appeal, gratis. I also heard that you can only appeal 3 times, not sure if that's just in Jersey, though. If that's true in your case, you need to make sure everything is written properly. Do you know if your surgeon has a lawyer to offer you?