Skalleywag

Please help, I just got a denial letter from my surgeons office saying that I didn't have 2 comorbids that have not responded to maximum medical management that are generally expected to be reversed or improved by bariatric treatment!!!! My BMI is 35.6 my comorbids are a high cholesterol of 254 and sleep apnea. I have had high cholesterol for years with no medication and I have had a sleep study done years ago but I dont use a cpap. Any ideas on how to appeal this decision?? My surgeon's office submitted all other requirements. I have tried other weight loss methods like weight watchers, used phen phen, atkins diet, dexatrim, slim fast, scarsdale medical diet, grapefruit diet, etc..Any info would help... I am desperate !!! I am scheduled for surgery on November 4th supposedly. Very upset and can't stop crying here..

Doing ok I guess. Gathering all my paperwork and working on a appeal letter. I have been doing research on my comorbidities and have found some very interesting information. I have found I am not really a candidate for cholesterol medication since I have had a complete hysterectomy and am in menopause. Studies show women put on meds have a 71% chance of getting type 2 diabetes ! and that my LDL is only at 174 which is high but not high enough to recommend meds. So I am putting all this in my appeal letter and we will see what happens. Thanks for thinking of me

I was denied again after my surgeon had a peer to peer consult with my insurance medical management physician. It is the "no documentation that I have responded to MAXIMUM MEDICAL MANAGEMENT". I am so devastated right now. If I try and gain weight to get to 40 BMI I would have to literally gain 40lbs! and then I would worry about being denied again! my surgery has been taken off the schedule after I have been on pre-op diet for a week ! No way to self pay they want $20,600 for surgery. I have contacted via email the obesity law people and I am waiting for a call from them. I am also waiting to hear from my actual surgeon to explain to me what exactly was said in peer to peer review. For maximum medical management it sounds like I need to be put on cholesterol medication (WHICH I REALLY DONT WANT) and a CPAP which I don't want either. I was told to lose weight and exercise to lower these risks and have tried and failed. My only other option is Mexico but my husband is not supportive of this idea even though I have told him of all the success stories people here have had. He worries about who do I goto in the states for follow up care and if my insurance would cover the follow up care for a procedure they would not cover?? any ideas or thoughts on any of this ???

my surgeon's diet is 3 shakes and 1 lean cuisine and 1 cup steamed veggies.

mine was I did not have co-morbids...but I do I have dyslipidemia and sleep apnea. Waiting for Surgeon office to do a peer to peer review. Still scheduled for surgery as of now but we will see....

So do you think if I get a updated sleep study and a just a prescript for high cholesterol would work?How long would I have to be on meds before I could be approved for surgery??

My insurance used to require a 6 month diet but recently got rid of that requirement in February of this year. So it's just the BMI 35 or higher plus 2 co-morbids or 40 BMI and no co-morbid. And psych eval and nut stuff which I have already completed.

I am writing a letter to submit to my insurance co and will be calling the surgery coordinator first thing in the am to see what she recommends. And then I will be calling the insurance co and bugging them. I am so angry and upset that I have my husband quoting "Rocky" saying it's not how you get knocked down but how hard you fight to get back up or something along those lines I will not be giving up !! I don't feel it's a option for me. Thanks everyone. Please keep the ideas coming anything helps. :wub:

Yes I have other conditions that are not qualifiers but my surgeon assured me he would put in paperwork to insurance co. Like stress incontinence , chronic back and neck pain, acid reflux, plantar fasciaitis etc. My insurance needs 2 comorbids which are diabetes, hypertension, osteoarthritis,sleep apnea, and dyslipidemia. I have sleep apnea and high cholesterol which both apply. So I don't know what else they want. So discouraging.

Ya sorry I did not clarify the denial was from my insurance co BCBS IL and went through coordinator at my surgeons office. I have researced my insurance policy and felt I had everything in order.

I guess it depends on your surgeon but I don't think you have messed up. My pre-op diet is 3 shakes and a lean cuisine for dinner per my surgeon and he also said if I had a special function or dinner to goto during pre-op that is was ok to do so. Being 2 days away from surgery has got to be so exciting !!! I can't wait to be on the loser bench !!!

I have told my husband who has been a huge supporter and my two teenage kids who are also very supportive and my 2 best friends one of which has had the lap band . They are supportive but also worry about me and they don't think I need to have the surgery ( they are both bigger than I am). I am on the fence about telling anyone else at this point. I may change my mind once I am approved for sure by the insurance co. I just don't want to have to explain myself for a personal decision to get healthy.

Why do you think it took so long for approval ??

Had my pre-op yesterday and paperwork is submitted to insurance company !!! Now the waiting game begins....so anxious ! I start liquid diet on Monday but am trying a few shakes etc now to see how it will go. My BMI was 35.6 when I started this process and my insurance needs 2 co-morbids to qualify. My surgeon seems to think it should be ok and the insurance will accept my high cholesterol and mild sleep apnea as qualifiers but I am still anxious. Anyone else have BLUECROSS/BLUESHIELD ILL ? and experience the same ? and what is turnaround time on approval??

Had my NUT appt today and went well. She did tell me she wants to see me one more time before surgery!! Was not prepared for that. I was told only 1 visit was needed. I have my pre-op visit tomorrow and the surgeon is supposed to submit all paperwork to insurance co tomorrow ! I emailed NUT and she assured me her paperwork will be submitted and all should be ok. Fingers crossed all goes well tomorrow and paperwork will be submitted with no delays ! This surgery needs to happen on the 4th !! Ready for the change.

Welcome !! do you have your date yet?? All kinds of support here ! Love Hawaii :wub:

We are going to be a great group !! My name is Colleen !!!!!

I am new here as well ! Good luck with your approval process. I am scheduled on Nov 4th but still have NUT appt and labs and EKG Monday and my Pre-op appt on Tuesday next week !! After Pre-op appt surgeon will submit to insurance co. Praying for a quick approval lol. Anyways good luck and this site is awesome for any and all info. :tongue2:

My Current weight now is 205.5 this am and my goal weight would be 130-135..I don't even remember being this weight and if I was it was not for long. I started gaining my weight being put on anti-depressants when I was 19. I have the mindset that this is going to happen !! Life changing surgery and all !!!

I am scheduled for November 4th for surgery. I have already had my psych appt and that went good. I have nut appt on the Oct 14th and then pre-op appt with surgeon on Oct 15th. Final paperwork will be submitted on the 15th and fingers crossed that approval will go without complications. Start 2 week liquid diet on Oct 21st!! So no Halloween candy for me! I am excited and nervous. Have not told very many people i don't want to be judged. I am sooo ready to start a new chapter in my life ! Praying everyone has a smooth approval and surgery ! :tongue2:

I am new here and I have a surgery date of November 4th. Very anxious about getting approved. I have my psych evaluation Monday and nutrition visit scheduled for October 14th. Would like to follow along with others with progress.