Cindy_Wisc

Would anyone have an example of an appeal letter that you wrote to your insurance company? My surgeon's office has been fighting with my insurance company and are filing an appeal and they suggested that I write a letter, too, and I'm not sure what I should write in it. This has been a very frustrating process for me and I think I need to give this my best shot. I am trying to get approval for VSG. You can e-mail me at cindys32@yahoo.com or leave a document here for me. Thank you so much!

Prior to attending the classes at my clinic, I checked with United Health and was told that my coverage included bariatric surgery for someone like me (39 BMI) that has co-morbidities. I thought I was home-free. I have a well-documented history of obesity, high blood pressure, elevated cholesterol and sleep apnea. I went ahead and took the classes and then my surgeon's office applied for insurance pre-approval and I was flat-out denied. They said my co-morbidities are well-controlled by medication so there was no reason for the surgery. WTH???? My surgeon has requested a peer-to-peer review but I'm wondering if there's is any chance of getting an approval now. Has anyone else had this same experience and what was your outcome? Thanks!

Still ongoing.... I filed an appeal and that got denied. I am now working on getting things pulled together to file a "Second Level Review" but I'm pretty sure that will also be denied. I just feel like I was lied to by all parties. My insurance said I was covered because I had co-morbidities but it didn't come out until the appeal that it had to be co-morbidities "uncontrolled by pharmacotherapy". My surgeon's office has worked with this insurance company before so I'm surprised they didn't know that level of detail. But to be fair I'm sure every policy is different. I am going to have another sleep study because the paperwork that got submitted was from a study in 2010 so I'm hoping that comes out 'bad' enough that I'll be covered. Good luck to you!

Isn't it too late for weights? The insurance was submitted with my beginning weight back in February.

Various reasons were given. The thing that ticked me off is that I had called to see if I had coverage and I met all the criteria but now that my surgeon submitted the paperwork for the VSG I'm getting all kinds of grief..... 1. They are saying that my co-morbidities are well-controlled with medication so they don't consider them true co-morbidities. 2. They said that my BMI had dropped to 35 a couple of years ago (which was true but I'm now back at BMI of 39). 3. They won't accept blood tests from 2 years ago showing that I was pre-diabetic. Guess I shouldn't have watched my diet like a hawk for a week before my latest blood tests were taken. 4. My surgeon missed the peer-to-peer review window and now UHC is denying the peer-to-peer request which means I am now in an appeal mode. This one ticks me off because this was the responsibility of my surgeon's office and they obviously missed the boat. 5. My surgeon's office neglected to send in my sleep study paperwork and had to do that later which caused some issues, too. The cards are stacked against me.

You are not alone! I have probably spent thousands of dollars over the last 30 years with WW.

Very happy for you! Insurance denied me and I'm waiting for my surgeon to have a Peer-to-Peer review. Keeping my fingers crossed.

I started this journey in February and I had been following the diet with the nutritionist with the idea that I would have my surgery. At this point I'm feeling very discouraged. I can't imagine the surgeon will have enough 'pull' to get them to pay. And now I've 'fallen off the wagon' and am eating like a crazy woman.

I have UHC Choice Plus and got denied. My surgeon is going to do a peer-to-peer review now. They said my co-morbidities are well-controlled by medication so the surgery isn't necessary.

Premier Protein ready-made shakes are my favorite. I've tried the Jay Robb and think those are very good, too.

In my experience, if you tell 5 people then those 5 people each tell someone and the information is then totally public. I am keeping my surgery a secret from everyone except my daughter and I'll just tell people that I'm eating right and working out. But everyone is different so you should go with your gut on this. Btw -- even with the surgery, the success comes from you eating right and working out so it's not like you would be telling a lie.

My colonoscopy doctor told me to take 1 TB of Miralax every day and that has helped a lot! I mix up a glass every morning with some Crystal Light.

Hi, Because of everyone's schedules it looks like I might be alone after I return home from my VSG. Has anyone else done this alone? Did you have any particular issues? Thanks!

I would be in the hospital the standard amount of time (2 or 3 days).