DreamsOfSkinny

Have you called your Dr.?

So update... I went to Dr. Today to find out my weights from my primary physician were never received by them and never given to my insurance, so mu insurance only had my weights after I had lost some lbs. for 2 out of the 5 years... I had to request those files to be faxed over gain today. Dr. Wanted me to write note with all these weights documented along with stating that the BMI the medical director said I am currently is inaccurate. He was puzzled how she even came to that number. I'm 5'2 and 220 which is 40.2 --- she had said I was denied because I wasn't currently over 40 and was 37.4. :-/ I called my insurance again and they gave me benefits criteria like I knew before and said I had to have my Dr. Send in information in to request a new peer to peer review since this one never happened. I then called my work and got a copy of the REAL criteria based off of my summary plan blah blah... It doesn't say anything about co-morbidities at all! It only states I need to be 40BMI currently. Show I've been "morbidly obese" for 5 years from physicians. Over 21. And go to in-network hospital. I meet all of those once the insurance gets my correct weights for 2 years and gets weight for my 5th year. So, there should be no reason not to be approved now, but knowing how much of an issue it's been I think the ins. Is going to say morbidly obese is 40+bmi... I just feel it coming so I looked it up and many medical practices say bmi 35+ is morbidly obese. I also called my job to tell them the issues I'm having with insurance giving me wrong information, denying me for inaccurate information on their part, not returning peer to peer calls, not sending me denial letter until 1 1/2 weeks later and then saying I only have 14 days to request peer to peer. My job has a 3rd party company that looks into all of this to make sure I'm receiving the care I need. Specialists should call me back Monday or Tuesday next week. Hopefully then all this bs can end and just approve me because I meet all criteria and we can all move on. Sad bc I work for such a Large company so I know they don't want their employees going through this with insurance. I'll post back again... I hope that this can help someone else. Don't give up or get discouraged.

Well I just found this group--which is fabulous!!-- and wanted to ask for prayers for God's will. Yes, although I have what I think I want, I'd rather ask for His perfect will for this journey. I've gone through what I need to to submit my first try into the insurance company. I am hoping that they don't require a 6 month diet or if they do they will take my previous documented 2, 3 month diets. I really want/need to have my surgery before the end of the year as I am already off of work for another surgery. Prayers please for Oct. 31st when I have hand surgery. I hope it helps me.

Well that's great! My doc was supposed to have my peer to peer today but when I called his office they dont even know if he did it but said he wants me to come in tomorrow to talk. :-/ Hoping this means a Good thing..... But think maybe denied again and he's trying to figure out more info to find a way to get it approved

My doc told me losing all the weight should help with headaches in general.

Well if you get it 100% free that's great. I have $2k more for my OOP max but that includes any medical treatments me and my family have so the surgery may cost me like $1500 after any other tests I need.

Wow! 9 months is a long time.

You look great!! Just wondering since you say you lost slower and you look young, are you having any loose skin issues?

I hope to join all of you soon! I've been denied and am having a peer to peer review on Thursday. Crossing fingers!!!

Omg!! 11 months! I think I'd pay OOP lol not patient at all

My Dr just told me to loose 10 lbs. I'm trying to appeal my ins. Denial but still want to lose the weight so if it is approved I'm ready to go! Are you on protein shakes? How many calories a day? Are you only clear liquids for 2 days prior to surgery?

And she said the insurance is just trying to find anything to not approve me. The Med. Dir. Called their office for a peer to peer at lunch time and left a message with the answering service. When my ins. Coordinator called back the ins. Said the peer to peer was already done. She was livid when i talked to her today. Coordinator said she scheduled it for Thursday an gave the Dr's cell phone to make sure they are reached this time. I am really not hopeful at this point and it'll probably go to an appeal but the coordinator said theres no reason they shouldn't approve me by their criteria bc I meet it all. So I'm just praying! I do have a a follow up appt with my surgeon this Friday which we were hoping to use as pre op so I guess if it gets approved I'll be ecstatic as I'll have pre op appt done and can schedule!!! Prayersssssss

So I called again and got ref. number for call stating that I only need 1 co-morbidity and bmi of 35+ for past 5 yrs although the medical Dir. Of Ins. Said I was denied bc I didnt have bmi of 40+. Second issue the insurance chose 2 of my lowest weights for 2 yrs and didnt even mark down for a whole year EVEN THOUGH my dr. Submitted all health documents! I talked to my ins. Coordinator at Dr office today

http://theworldaccordingtoeggface.blogspot.com/2010/03/plan-for-success.html?m=1 Just found this blog that has a lot of quick and easy -portion controlled- meals and ideas on how to get your protein in. She makes tons of things from the powders.

Just curious if anyone has gotten this type of denial overturned. What did you do? My ins states I need 35 bmi + 2 comorbities for last 5 yrs. 3 or 4 out of the five I'm over 35 and more like 38-41 (current 40.6). My ins. States the next step is having my dr. Do a peer review by having a call w/the medical director that denied it.....any ideas?

I were told these were as well as another issue I was dx'ed with---intercranial hypertension

I hope so too and that my surgeon can make whatever case he needs to for that phone call.