stinksmom

So just received the bad news about 1 1/2 weeks ago. I was denied, my insurance company stated that I haven't had the BMI of over 40 for the past 3 years, along with that because its not documented with my doctor that I Have been trying to lose weight for the past 2 years. The office manager at the surgeons office stated that this is where we being to fit. I fit all the co-morbid qualifications, etc. it's this stipulation in my policy. I am in the process of writing an appeal letter, having a co-worker of mine write a letter stating that she gave me the info for different diets that she was on. She was able to afford to go to the programs, unfortunately I wasn't able to afford it but able to follow them.I've left a message for my PCP to call me to see if she can write a letter and state that she feels it's medically necessary for me to have this procedure done. I've also been able to obtain copies of the past 2 years gym contracts to submit for review. Any other suggestions?

I'm new to all of this. Anxious & scared. I have started the process in June 2010 with the testing etc. My tentative date is 9-15 -10. Apparently I had to finish all my pre-testing - (which I met my out of pocket expense for insurance), have all documentation and letter from my primary care physician. Waiting for info to be submitted to insurance for approval. Everyone keep praying & your fingers crossed.

Just recv'd phone call from the surgeon's office. She stated that the insurance company called and said that I was denied. that I haven't had a BMI of over 40% for 3yrs and or documentation of weight loss discussions from my PCP. I'm totally bummed at this point. The surgeon's office manager said to wait for the denial letter so we can appeal it together. She also said they work with someone from LAP band that get's involved as well.... I'm still praying!!

I have BC/BS of Iowa- and its a PPO. I was just denied surgery. They stated that I wasn't @ a 40% BMI for the past 3 years. I weigh 269 and I'm about 5 5 1/2. I also didn't have any "proof" of past diet attempts in my dr's records as really the only time I went was when I was sick. We didn't discuss my weight.I am waiting for my denial letter so I can appeal it. Not only am I morbidly obese now- I'm pre-diabetic, Hypertensive and have high cholesterol. Both my PCP and a cardiologist stated that it was highly reccommended.. Anyone have any ideas how to change their decision?

Good luck kfields. I know you are excited. Hopefully I will know something by Monday.

I haven't been approved for the surgery yet. Awaiting insurance decision but I am aware of the pre-op diet. MY surgeon requires 10 day liquid diet. I have tried 3 of the flavors. Strawberry, Vanilla & Chocolate. I've used 1 Vanilla CIB, 3/4 cup of soy milk or fat free milk, a little bit of ice, 1 banana and then 1/2 cup of various frozen fruits (strawberries, raspberries, mangoes etc. For the Strawberry CIB I do the same. Chocolate I use the milk, banana, ice and add a teaspoon of peanut butter or Nutella. My favorite is the Vanilla with the Mango! Hope this helps. At least I know now which to stock up on when (if) my insurance approves me....

Talk about being sick to my stomach. I have been on this roller coaster since August with Blus Cross Blue shield of IOWA. My tentative surgery date was 9-15-10, but pushed it to 9-29. I am scheduled for pre- op testing on 9-23- still don't have approval for insurance. They keep requesting more and more information. Now they are stating that they need 2 years worth of diet attempts- which I don't have any paper work for. However I have requested contracts from the gym that I go to.- (which cost $$ to obtain) and 3 years worth of weight history from my doctor. I have exceeded my out ofpocket expense with all of these tests, and on top of that I have to pay a $2000 co-pay + 20% of the surgery UP FRONT. I am getting discouraged, and frustrated...

I have BC/BS as well. Every plan is different. I have so many stipulations and tests that need to be completed before I can even submit for approval for the surgery. I started my journey June 2010- **$1500 later (out of pocket expense for insurance) I'm waiting for approval. My "tentative" date is 9/15/10- along with a $2000 co-pay. I'm afraid that if I don't get approved I just blew $1500 on unnecessary tests. I'm still saving for the $2000 co-pay! Good luck!

If my insurance approves the surgery, I'll be starting the pre-op diet the 1st week of Sept. Thanks for the info....