Melody

Well.... BUMMMER.. Just got off the phone with Cigna who transferred me over to the company they use for the bypass called Intra Core and found out that I have been DENIED! My heart just dropped... geez. So i asked her what the reasoning was and she said because there wasn't 26 weeks of documented medically supervised weight loss attempts. This is the pits.. that will mean I will have to see what my primary doctor can write up and then I will have to appeal. This just sucks!


Melody
(pre-op Dr. Callery)

Blueyz

Melody,
I know exactly how you are feeling. I had to appeal, too. I was ready to give up and said nope! I am going to fight. I submitted all of my proof and then my doctor resubmitted the referral and I was approved. Please do not give up. If you need anything, email me privately.
Good luck.

__________________
Blueyz
Open 7/14/04 w/Dr. Callery 4 years out
239/103/125 below Goal fluctuating between 108-115
BMI 18.8~Dr. C is ok with my weight...yeah

Official Scale Whore # 27 (Recovered..I threw mine out!!)

bridgetgirl

I am so sorry to hear about that n stuff. Im sure you will find someone here that can help you... maybe consider hiring an attorney for some help. There are obesity law lawyers out there ya know.... Did you do the 6 weeks of documented weight loss or no? Whatever it is, I know you will get great assistance from someone here. Remember we are lucky in this forum, so far everything has gone well for everyone with regards to getting their surgery.. look at Richard.. he got approved through Kaiser to go to Dr. C, and the other gal who needed her surgery before Sept 1... that is gonna happen... and it's gonna happen for you too sugar pea! I wish I could be more of a help to you... get with Dale and anybody else that says they can help. Good luck! ((HUGS))

__________________
J.Bridget Fisher aka koi-pea
2/9/04 lap 5'11"
298/170-trying to lose another 10

www.myspace.com/caliclovercutie
What Sawyer would call me on LOST: ladybug

"People will argue with you that getting what you want in life isn’t something you can learn, if you’re destined to be one of the worlds winners as opposed to one of its perpetual whiners, its because you have been born with the right talents and temperament and have a big dose of self-esteem, ambition, and good judgment." Kate White

Phebius

Hello Melody & All...I haven't posted in I don't know how long, but I have been trying to keep up with all the posts. Everyone looks so good and doing really well despite some of the "bumps" in that preverbial road. My congratulations go out to everyone! You all look so beautiful and happy! I know it's been a long year for me, but I am estatic...there is nothing like a new lease on life.

Melody, I know exactly how you feel because I was denied twice! I was heartbroken. The first time, I just said "oh well" and proceeded on trying to lose weight with yet another diet. After a year passed, I attempted again and got denied again...they said because I didn't meet the qualifications (no comorbidities to be exact) I wasn't a candidate for the bypass surgery. Well, I sent an appeal letter to my insurance company and I threw all the industry's weight guidelines back in their face, listed all the diets I had been on, and my weight predispositions (family history). Also, I pointed out the fact that to take care of all the "illnesses" associated with being obese would cost more than the surgery over the long period. I told them that preventative medicine was the best medicine and that I just couldn't spend thousands of dollars a year anymore under a supervised diet plan. I was doing Jenny Craig for about a year and a half and had spent at least $5,000.00. I forwarded all that (my records from Jenny Craig) to my insurance company and after a few weeks of review, I was in!

I do have to admit that my counselor at Jenny Craig was the best especially helping me obtain my records, and the representative from my insurance company was a total sweetheart, I really think she made a big difference for me. I thank God for her all the time, but I did take the time to build a rapport (sp?) with her and of course that worked in my favor.

Things are so different just from a year ago with the surgery itself and getting approved from the insurance companies, but this country's health system is based on prescribing a pill rather than preventative medicine, but I think it's slowly changing.

I don't know if you have any sort of documentation from a supervised weight loss program, but that seems to be the norm now. If you do, from wherever, especially if it's from more than one place, get your paperwork together and get it to your insurance company ASAP with your letter of appeal. I sent my stuff UPS Overnight, directly to my representative, followed up, and said "thank you" and "please" alot...lol. If you don't have the documentation from places like Jenny Craig or Weight Watchers, etc., then maybe you're right and your doctor can write up something saying he/she has been supervising your weight loss. How long have you been with your PCP? Have you been to see a nutritionist/dietician? I told my insurance company to go "look up" the referral they had given me to a nutritionist...that put them in their place a little bit as far as documented attempted weight loss too.

I wish I still had my appeal letter, but my computer crashed and that's where it was...I would have been glad to share it with anyone. If you need someone to give you any feedback on an appeal letter, I would be more than happy to help...I know exactly how you feel, and without my "home" and "work" support team, I may have never gotten the appeal letter written.

I do wish you the best of luck with your appeal...you will be having your surgery soon, just stay on top of them and make the insurance company work for you, afterall, you do pay the premiums.

Take Care,
Pamela
Open 08/26/03
272/143/120

watergirl

DO NOT GIVE UP! I've known of three friends that apealed and won. I have two awesome appeal letters. If you e-mail me off line, provide me with a fax number and I'll fax them over to you. Do not give up! You will win with patience and persistance. I feel your pain.

__________________
Kim
On the road of life, it's not where you go, gut who's by your side that makes the difference.

Wherever you go....there you are.

Wrinkles only go where the smiles have been. - Jimmy Buffett

Lap RNY 8.9.04
266/130
Start BMI 41.6
Current BMI 19.9 I'm finally NORMAL! No longer Morbidly Obese, Obese or Overweight!

Myspace: My URL
http://www.myspace.com/h2o_woman

Karen Wright

__________________
~Karen
Open RNY 04/13/04
313/230/158 (still pushing for that goal!)

"Don't take yourself so darn seriously!" Rule # 62

Melody

Thank you all for your input and support. I am in the process of writing an appeal letter. Didn't Stuart also mention there was an attorney he used? Stuart can you give me the details on that?

Thanks everyone! I'm not giving up!

Melody
(pre-op Dr. Callery)

Christina

Melody,

You are right, Stuart did use a lawyer and won and obviously had the surgery and is doing spectacular!!

I'll make sure that he gets you the info ok girlfriend..

In the meantime, hang in there.. and take a deep breath your turn is coming..

__________________
Christina
Open RNY 03/31/2004
274/128/137 (131 Per Dr. C)
BMI: 47 / 22

"There's nothing noble in being superior to your fellow men. True nobility is being superior to your former self." - Ernest Miller Hemingway

"Obstacles are those frightful things you see when you take your eyes off your goal." - Henry Ford

Melody

Thank you Christina! I'm hanging in there.. trying not to get discouraged. My problem is the 26 weeks of documented weight loss. Let me know what he says.

Thanks!
Melody