sharonk

Why didnt they just do both surgeries at the same time?

Well, it's been officially over 6 months since my first appeal being denied which means,supposedly (according to my job's insurance contact), I can re-sumbit my full/complete packet for surgery once more. This time they will submit as a whole new request. We have gathered additonal and new documents so if i dont get it passed this time, i'm out of luck for surgery (selfpay is not an option for me). Through countless appeals (another long winded story in itself) and my insurance not giving accurate information, this process has been excessively long/draining/frustrating. I still have a complaint filed with the state's (pa) insurance commissioner. Whether it helps my case or not someone needs to know that insurance companies cant/shouldnt treat their paying memebers this way. We should be given any and all info and informed properly of procedures and information if/ when we ask for it!! Plus, maybe it will help someone else who may be going through the same thing...although who knows!! Has anyone had any experience with filing a formal complaint? Did it help you in your case? Any who, i'm hoping this will be it and i'll have an answer by the end of july. The "approved" answer. Im staying as positive as i can. As always, good luck to all!!

Yes, i know of it. Not really looking to spend the money. Thanks though!

I have highmark bcbs which is located out of pittsburgh...not sure if thats the same but DEFINITELY sounds familar. She should fule a complaint!

Thanks guys...i hope so too christina!! My husband now just shakes his head anytime i mention the latest news/ progress. I pretty much keep it to myself nowadays. Lol

I am going through the same thing....they denied it because my original paperwork from my pcp who supervised my 6 months is not sufficient and that there was no documentation showing him working with a nutritionist. Its all so confusing and so generalized so i have submitted things over and over again trying to get it approved. Not to mention a half a**ed peer on peer review (another stupid story). After having my human resource contact, at work, contact her peeps i was told i needed documentation from a registered nutrionist/ dietician for the FULL 6 months and not just from our initial meeting. LUCKILY, i attended 7 months worth of support group meetings and the band drs office's onsite nutritionist was the group leader. She gave me each month's sign in roster that showed my attendence and over 30 pages of documentation showing what was dicussed at each meeting. I also had to get my pcp to give me his office notes for each of my visits. (That was like pulling teeth for some reason) NOW, im back to waiting as i am now re-applying after 6 months of appeals. Good luck, i hope your peer on peer goes better than mine went!!

I am going through the same thing....they denied it because my original paperwork from my pcp who supervised my 6 months is not sufficient and that there was no documentation showing him working with a nutritionist. Its all so confusing and so generalized so i have submitted things over and over again trying to get it approved. Not to mention a half a**ed peer on peer review (another stupid story). After having my human resource contact, at work, contact her peeps i was told i needed documentation from a registered nutrionist/ dietician for the FULL 6 months and not just from our initial meeting. LUCKILY, i attended 7 months worth of support group meetings and the band drs office's onsite nutritionist was the group leader. She gave me each month's sign in roster that showed my attendence and over 30 pages of documentation showing what was dicussed at each meeting. I also had to get my pcp to give me his office notes for each of my visits. (That was like pulling teeth for some reason) NOW, im back to waiting as i am now re-applying after 6 months of appeals. Good luck, i hope your peer on peer goes better than mine went!!

I think any insurance company plays very strictly to its rules. Remember they are out to make profit not spend money so follow your policy to a t if i were you. Im on my 4th appeal right now because information sent was not sufficient/accurate. Good luck

Okay so just got word that i have been denied for the 4th time...Bah humbug!! this time around i wrote my own personal letter to my insurance greivance dept. I asked them to reconsider their answer and also supplied more info on the req 6 month supervision that they previously have said there wasnt sufficient info on and i was going off the basis that my dr had resubmitted my bmi at 40. Originally my dr's office submitted all my paperwork at 39 bmi with hperlipidemia but that didnt qualify according to my insurance. So, my dr's office said they resubmitted my bmi as 40 and that would make me qualify. Well insurance is saying that nothing was ever submitted showing a 40 bmi. WTF!!! Xcuse my french. Now i need to have my dr resubmit again and im sure ill have to wait ANOTHER 30 days to hear what im sure will be "denied". Yep, i keep saying this is it, i'm not going thru anymore appeals and then i hear such simple reasons for denial, things that i can simply send in to correct and i try and try again. They make it sound so easy to just resubmit what they need but yet my life and health is on hold. Not to mention my 5 vacation days that i have held out for, for the past year, just in case i do one day get approved. Ha, who knew at this point all i can do is let out a laugh and a shake of my head! Serenity now

THanks dhales and dionaw! i actually just spoke to my band dr's office and i'm going to stop by there tomorrow and do a weigh in so they can get the 40 bmi put down on paper and then they will resend. I actually offered to do this back then but they never requested me to do it. i guess the next time i post a new thread will be in another month. Maybe, next time will be me saying holy crapola, i'm approved. lol, yeah right! i can only hope though! hey, at least i'm at the point that i laugh, where as on the 3rd denial i broke down and cried my eyes out. my closest friend who i tell all this crazy stuff to wonders how i can not be freaking out on these people. i guess that's just not my nature.

i had already offered my family dr.s info and telephone #. Apparently now it's just the wrong info on my BMI which i thought was previously corrected on the peer on peer review 1-1/2 months ago.

Congrats!!

Oops, posted to many times. :/

I say appeal it but get a copy of all the paperwork your dr. submitted to insurance. I have been denied three times now and still appealing. the first mistake i made was not getting my very own copy of what was submitted. I just kept assuming the staff at the dr. office was sending the right info. I just recently (last week) sent in my own appeal and awaiting their decision. I think the more info you know and have in front of you, the better off you will be. Good luck!! I say appeal it but get a copy of all the paperwork your dr. submitted to insurance. I have been denied three times now and still appealing. the first mistake i made was not getting my very own copy of what was submitted. I just kept assuming the staff at the dr. office was sending the right info. I just recently (last week) sent in my own appeal and awaiting their decision. I think the more info you know and have in front of you, the better off you will be. Good luck!! Oops...posted too many time :/

I say appeal it but get a copy of all the paperwork your dr. submitted to insurance. I have been denied three times now and still appealing. the first mistake i made was not getting my very own copy of what was submitted. I just kept assuming the staff at the dr. office was sending the right info. I just recently (last week) sent in my own appeal and awaiting their decision. I think the more info you know and have in front of you, the better off you will be. Good luck!!

I just got denied a 3rd time! I dont know what i want to do at this point. Im angry sad confused! Finally emotionally drained at the thought of appealing on my own behalf, which insurance said i could do. I called the drs office and told them i would like to come by and pick up all the documents that were submitted. They told me they will have to put everything together and will call me next week when its ready. Wait, why isnt it ready now?! Wth?! Didnt they just resubmit my info this week?! I dont get it!! I started at 39 bmi now im 40 bmi so i dont need the comorbids and my dr office states that the 40bmi is what was submitted this past week for the dr on dr review. ive done my 6 months, pysch exam, test, consults. Trust me when i say i have done EVERYTHING my insurance medical policy has stated!! Ive read it a trillion times!! I cant get an exact answer from insurance rep because the info hasnt been entered into their system yet. So basically im back to waiting and trying to figure out in my head what it could be. Maybe my drs office has something wrong?! I dont know?! They did seem a little weirded out that i was requesting all the paperwork but hey this isnt their life so why would they be as particular with the info, right?! Any who, im going to TRY not to think about this too much over the weekend maybe a few drinks will help me forget. i think i will review my packet and then decide from there what to do. Thanks to those out there in band land listening to me vent! I pray others have better luck than me.

I ended up only getting the 6 month write up because thats what insurance is currently denying it on.

Oh wow, good for you for sticking with it. I just mailed a letter to the appeals and grievences dept with my insurance company and i included the same 6 month diet write up alomg with my own write up. Im sure they will disregard mine but i figured it was worth a try. I just hope it doesnt hurt my case...you never know with these people! I also will have one more shot at a peer on peer appeal once my band dr comes back from vacation which is in early april. He agreed to try it again since he nevwr even had the chamce to discuss my case in full. Im keeping my fingers crossed but im also not getting my hopes up.

Thanks tracy...im going to gather up the documents from my drs office so i can see exactly what my insurance is seeing! My guess right now is the paperwork is the problem bu i will keep this info handy!

Just called my insurance and found out they have denied me for the second time! :( i have a bmi of 39 and must have a comorbitity. Well the first time they said there wasnt enough paperwork submitted by my pcp. This time i have yet to find out why until they send the letter in the mail but my drs office believes its because they think I'm too skinny and I'm only borderline comorbitity! They are going to do the Dr on Dr call next but i have a feeling I'm going to be denied across the board! So dissapointed and totally don't think its fair that insurance makes you take all these steps only to find out your not going to be covered! Ive been on this journey since mar2011! Something is just plain wrong with this! I know everyone says keep at it but damn this is emotionally draining and unfair!!

Dont know yet since insurance is not showing it in their system yet. Guess i have to wait for the denial letter or call again next week.

Dont know yet since insurance is not showing it in their system yet. Guess i have to wait for the denial letter or call again next week.

Ppo...i couldnt find any stipulations on their policy but thats not to say it isnt there. Obesitylaw i believe cost money?! I refuse to pay someone to get me an approval when i know myslef that i have done everything. Im seriously thinking it may be my drs office who is not submitting the proper paperwork. I will wait till april and go from there. Thanks for all the support it reminds me im not alone!!

Bcbs located in pa