Heyher

I am still in the stage waiting for approval. I come on here for inspiration and to cheer on others progress. I am so happy for all the success others have had. It is so awesome to read and see everyone progress. But I am six months from when I went to the seminar. Three months from when my first attempt for approval was submitteded. And I didn't even have to do the diet. I'm trying to stay positive. But when is my turn? Why can't I call insurance and hear that magical word approved? I have heard denied 4 times from insurance. I'm losing hope and I'm getting the sinking feeling that my external appeal will be denied. Self pay is out of the question. All money is going to wedding and our new house...

Tattoos take about a month to heal. Depending on the location some are quicker some are slower. Larger tattoos take longer as well because they obviously cover a bigger area. Just remember a new tattoo is basically an open wound. If it gets infected or you have a reaction to the ink, it could delay surgery until it is calmed down.

My insurance has such strict rules about the requirements. There is no wiggle room and nothing about comorbidities. Thing is I have MS and fibro on top of comorbidities. So weight loss is hard. Too hot and I get too fatigued I can barely walk. Too cold and my body hurts too much to move. It's kind of a sucky situation. :-) Hearing no all the time kind of chips away at the positive attitude I had about approval.

Realizing there is the potential for a problem before it turns into a real problem is a big deal. I agree with the other poster about buying a smaller bottle and saying that is it for the weekend. Then move to not having in the house at all. Maybe talk to someone who is a professional. Not hard core psych sessions. But talking to a person who is unbiased can help you find a better hobby. It is a slippery slope and glad to hear you are paying attention before things got bad. We are all at risk of transferring addiction. Maybe try excersize or volunteering with a cause you feel strongly about. Something to keep your mind engaged so alcohol doesn't become the main focus. Good luck and please let us know how things progress. :-)

CDC and medical guidelines defines it as 40+. Self funded plans follow ERISA which is federal law enacted in the 70's i believe. ERISA insurance policies tends to follow CDC definitions of morbid obesity. How your company worded the requirements is how the insurance has to enforce it. And most times the insurance plan is not allowed to deviate from the plan written by the funding company (employer).

Thankful it isn't a leak. But will keep praying with my fingers crossed you can tolerate liquid. Also that your sleeve corrects itself and no further operations are needed. So sorry to hear you are going through this.

Looks like they have until Jan 19th to make a decision. Almost 7 months to the day that I decided to have surgery. I hope who ever does the external appeal really considers all the factors in why I need the surgery. Pretty sure I'll be calling once a week to find out the status. Until then I'll be a bundle of nerves. Also found out the only reason I was denied is because they are not allowed to deviate from the plan at all and my plan doesn't allow for any exceptions. Strict plan...

Sent in 1st request in September. That was denied. Peer to peer two weeks later and denied. 1st appeal denied 10/23. Sent what I thought was external appeal 11/7. Turned out to be 2nd appeal. That was denied 11/21. Sent in request for external appeal today. Called to find out what time limit ERISA self funded plans have for IRO decision. First I was told they only did one appeal and that's what was denied 11/21. And what I sent in today was 2nd appeal. And that most of the time UHC didn't typically allow external appeals on my plan. Then they tried to tell me WLS isn't covered under my plan. I was livid... It is covered. It lists it on the summary plan description. I have denial letters for first level and second level appeal. On the second denial letter it states to send for external appeal... Almost threw in the towel today. My mom said that's what they want. For people to give up and not fight. And that I had to fight for this because I need it like she needed the RNY. Just so sick of the games.

Insurance called to let me know my external appeal has been sent and I will know the final decision in 30 days.

So I thought we sent the request for external review with the IRO. Well UHC denied my 2nd level appeal. So have to submit AGAIN to get it to the IRO. What the crap???? Sorry, insurance is sooooo screwy some times.

Is there another surgeon you can talk to at a different location? Maybe find someone who has expierences with this situation? Don't give up. Worst case, call insurance and ask about out of network doctors.

Praying with fingers crossed that everything works for you.

@Dreams Why are they canceling your insurance if you don't get surgery? @Stacy Doctors in Mexico have different requirements for surgery. And insurance policies have different requirements here in the states. This week I was told by one rep that WLS is not a covered benefit. Ummm yes it is. Then I was told by a supervisor that external appeals are not allowed on my plan. Ummm yes they are. BUT I think my external review was finally sent off.

I know it's medically necessary. I have hypertension, sleep apnea, acid reflux, arthritis, pre-diabetic, fibromyalgea, ms, and other things. It is my plan that has been my nightmare. They want me to be at 40+ for 5+ consecutive years. I can't do that with the ms. My grandma passed away at 62 because she was morbidly obese with diabetes. She had congestive heart failure because of her weight and health issues. We sent all kinds of documentation and my personal letter siting medical facts, family history, and reasoning for why I want the sleeve. I hope it works and the IRO can get past 40+ for 5+ years..,.

I can't afford self pay here in the states or in Mexico. So insurance or nothing.... :-(

So I sent in the request for external review this morning. 58 pages of diagnosis, medical studies, tests, letters, ect. Also wrote a three page letter about why this surgery is needed. Doc office should be sending in their portion today too. Hope they see the benefits of surgery for me.

Do you have a description of benefits? Or a summary plan description? Summary plan description is self funded.

Depends on if it's fully insured or self funded. Fully insured reports to state regulation. Self funded follow federal law under ERISA.

Just wanted to say I'm so mad I'm shaking These plan administrators will get theirs on the day of reckoning. NOW I can submit for external review. Self insured plans are a joke.

This is a large LARGE company operating in 7 states. There are three operating companies working under 1 service company. We have the board of directors. We have opco presidents. CEO, CFO, directors, managing directors, and every level of management you can imagine. I am working with the vendor manager in the benifits department. They can not allow an exception because of the fiduciary process. The plan administrator told them what to do and we did what they said. Then it was denied. We followed what they said for appeal. That was denied. We sent what we were told would be the external appeal. It was another internal appeal. And that was denied. First appeal noted some comorbidities but not all. Used some weights, but not all. Next appeal they noted other comorbidities, but again not all. Used different weights, but again not all. This is a joke. Again if people take offense to personal feelings, then why not just move on and let it be? My statement was directed at NO ONE. But people still have to pick fights. SMH. Starting to see why so many people have left this forum. Can't state their frustrations without someone getting offended. Public forum blah blah blah. Self funded sucks for the little guy. Get over it.

Fertility treatments are covers as is WLS. But the requirements are so hard for a majority to qualify. They offer a lot of coverage, and my $4400 meds are covered. And i am so thankful for that. But the plan is putting up roadblock and just testing my resolve to get this surgery. I'm sure your employees have moments of frustration with your perfect plan. My company is trying to please about 18,000 employees. And they are trying to help. But the plan administrator is using different information to deny each time. So THAT is why I am pissed. And THAT is why I say it's a scam. I have even read about how self funded plan administrators use lowest weights and find the smallest reason to deny. So I think I have a right to vent, and if people don't like what I say, don't respond.

If your doc won't help, get your records from them and find a doc who will. This isn't his decision. It is yours. If they won't support it, then find someone who will. When it comes to this surgery you will know better then the doc if it's what you want and what you need. Just a side note they say you shouldn't get pregnant until you are a year out of surgery. Fingers crossed your doc will help on this journey. If not, there are plenty who will.

Who did your sleeve? I'm still preop, but I hope for not much longer. I would love to be sleeved in January, so keeping my fingers toes arms and legs crossed.,,

I keep hearing UHC likes to deny up to three times before approving this type surgery. As soon as I have my latest denial letter I am sending in the request for an expedited external review. Thought I had done that, but UHC wanted to tell me no one more time. Jerks. But now it is outof their hands. Thank god for the IRO.