newlife4me

Well, after 7months of jumping through hoops I recieved my "DENIED" letter.
What a huge disapointment. I understand that may be the way things are going. Many insurance co. are saying no first then waiting for the case to say yes. I had kinda been planning my life around the surgery. Get this done before the surgery, wait for this until after.........this really sucks.
I will call and see what the heck.
Sure do wish I were independently wealthy so I could tell the insurance folks to take a big Flyer!!!!!!
Thanks for being there
Lori

__________________
Date:07/06/2006
297---worst
290---start of program
286---pre op
167---now:
155 a more realistic, DR. inspired goal.

LisaM

Don't let it stop there, girl, appeal! I know that Tawanda wrote an appeal letter, and others have appealed successfully. Anyone who's written an appeal letter, what needs to be in it?

__________________
Lisa M

Lap RNY - 9/26/05
surgery/lowest/goal
Weight: 303/137/150
BMI: 56/25.1/27.4
Now in maintenance stage, with desired weight range: 150-153 pounds
Current weight: 143 Updated 7/16/08

"Never be bullied into silence. Never allow yourself to be made a victim. Accept no one's definition of your life; define yourself." Harvey Fierstein

newlife4me

Hey yeah, Maybe I could get some advise on what procedures to take. I know I have to be the one to do it.

HELP!!!!!!!!!

__________________
Date:07/06/2006
297---worst
290---start of program
286---pre op
167---now:
155 a more realistic, DR. inspired goal.

LizardQueen

APPEAL!!!! Don't give up! call and demand to know exactly why you were denied and exactly what you have to do to have the decision reversed. Got my fingers and toes crossed for you!

__________________
Amber
Open RNY 2/22/05
278/103.5 way below goal

Cinerbelle

Hi Lori,

What insurance do you have...you are freaking me out.

APPEAL APPEAL APPEAL!!

__________________

newlife4me

It is Aetna. It seems they have some new 157 rule or something I don't exactly understand.

__________________
Date:07/06/2006
297---worst
290---start of program
286---pre op
167---now:
155 a more realistic, DR. inspired goal.

Gina in NY

You might want to pick up the book - it has LOTS of information about appealing a denial. You have not yet begun to fight!!

Good luck!

__________________
Gina in NY
288/261/137- 5'3"
High/Pre-op/Current
Goal - 19% BF. Dr. Goal - 150 My goal: 126
Open RNY 6/20/06 Plastics 7/27/07
TT Gym rat club member #5

Bypassingme619

Lori never give up. You do have a right to appeal. Find out what it is you need to get that approval. Lori a lot of people have been denied their first time around or even all the way to legal action. I will be rooting for you sweety. Keep us posted on how things turn out. Don't give up.

__________________
Your Girl,
Denise

Dr. Mueller
7/14/05 Lap
411 /310/180 (I don't want to be skinny)


My Story

My Space

Never put a question mark where the Lord has already put a period.

Cinerbelle

Oh, that sucks....I have Aetna too, but in California it is state mandated that if you meet the criteria then they can't deny you...unless your company has specifically cut WLS out of the plan. Good luck, I have read a lot on other WLS boards that once you appeal you usually get approved. Let me know how it goes.

__________________

Tawanda

Lori

Don't give up! I'll make a deal with you. I'll be your Idaho support if you'll be mine! We'll show those insurance companies what they get when they tick off us "spuds"!

I did write an appeal, but Denise is right...find out specifically what they didn't like about your pre-claim and address that. My insurance said I have the right to two appeals and I'll bet Aetna is the same.

Don't let this discourage you. We'll be right here by you, lending support and strong shoulders. You can do this! I know it's frustrating. Lord knows I've been whannying for two weeks now, so know that you are not alone. I'll be glad to help you over the hump.

Now...need to borrow my sledge hammer?

__________________
"If you're gonna walk on thin ice, you might as well dance...!!"

10/05-315/current-235/goal-185
5'10"
Insurance Denied 2nd Appeal-12/05
22 months of the "Tawanda Diet and Exercise Plan"