healthyliving

Update: I appealed the decision through the Insurance Administration JUST to find out that MY insurance does not have to answer to them! I AM SO SAD! I don't know where or what to do and a lawyer is over a grand. Don't have that just sitting around for a MAYBE....lol. UGHHHHH!!!!!

Thank-you so much for the words of comfort and encouragement. I hope it all works out for me. I love reading the stories from you all and all of your experiences!

Ugh, @FatBgone, that is my biggest fear. That it will go all this way and they will still deny, deny, deny! I have a PPO and apparently they can make their own rules. This is what I was told. Part of me wants to just get a loan and get it done, but another part of me thinks they SHOULD pay for it. I have paid enough money to them to pay for this surgery five times over. I am SO frustrated and I don't want to go into debt for the amount of the surgery. This is going to bug me for sure....I hate to allow others to have any type of power over my thoughts and I am very big in meditating and letting things go....but THIS is sticking....#so angry#

So, my insurance denied my appeal and I freaked out! Once I calmed down I contacted the attorney general's office in my area!! I can't tell you how calming and helpful they were. Apparently, my insurance company denied me TWICE because in their medical policy it states that VSG is reserved for those with a BMI of 50+ and because I fall below that it's NOT considered medically necessary. Does that sound CRAZY to you?? So I had to draft a letter telling why I think VSG is absolutely medically necessary and send it to the attorney general's office and my insurance company. Please feel free to send me any advice or words of comfort. Have any of you EVER had to deal with your insurance company on this level, and if so....HAS ANYONE EVER BEEN APPROVED?? I am so anxious I can hardly think straight....lol. UGH!!!:blink:

Ok, so I am totally upset, disappointed, confused...etc? I was denied by my insurance (bcbs-national acct) after an appeal because apparently I have to have a BMI of 50+ for the sleeve. I understand they are considering that the sleeve is usually done as a firt step for patients who will later receive a bypass, but obviously that's not me. I am approved for the bypass or the band but NOT the sleeve. I refuse to settle when I have been a faithful customer for YEARS with my insurance company. I have been diagnosed with pre-diabetes, asthma, joint problems; amongst other issues. I just don't know how to get past this stage. I was scheduled for surgery tomorrow and I had to get it moved to another month because of my denial. My BMI is currently 40.9. Does anyone know how I can get past this stage? I am thinking I need to write my own personal appeal letter explaining in detail my story. Do you think this may help!!?!! Any ideas, suggestions would be greatly appreciated!!!! Thanks Peace & blessings...

Ok, so I am totally upset, disappointed, confused...etc? I was denied by my insurance (bcbs-national acct) after an appeal because apparently I have to have a BMI of 50+ for the sleeve. I understand they are considering that the sleeve is usually done as a firt step for patients who will later receive a bypass, but obviously that's not me. I am approved for the bypass or the band but NOT the sleeve. I refuse to settle when I have been a faithful customer for YEARS with my insurance company. I have been diagnosed with pre-diabetes, asthma, joint problems; amongst other issues. I just don't know how to get past this stage. I was scheduled for surgery tomorrow and I had to get it moved to another month because of my denial. My BMI is currently 40.9. Does anyone know how I can get past this stage? I am thinking I need to write my own personal appeal letter explaining in detail my story. Do you think this may help!!?!! Any ideas, suggestions would be greatly appreciated!!!! Thanks Peace & blessings...

Wow, thank you all so much for your words of encouragement. I am trying not to get too down. They are going to appeal it and I should know in another week or so. I thought 50 seemed pretty high too but I think Virginia S. hit it right on the nose. That is exactly why they denied me. Either way I have to lose the weight....so I will keep meditating on it and please feel free to send any prayers and meditations my way. I will also continue to send out positive vibes to all of you Peace & blessings

Thank-you all for your concern. It really is a bummer and my husband thinks It's a sign that I should not get it. Feeling pretty bummed about all of it. Unfortunately, right now I am not able to self pay. If I could I would get it tomorrow. My BMI is 40.9.

OMG.....I can't believe my insurance denied me because (for the sleeve) your BMI has to be more than 50 to get approved!!! I am BEYOND devastated. Trying to keep a calm mind about it but darn it, I need help.....I have already purchased my post-op food and all of my vitamins. Has anyone ever experienced this before?? If so, did it get appealed? I would love to hear your story....anybody? :(