Jump to content
×
Are you looking for the BariatricPal Store? Go now!

What can I do? I am so frustrated.



Recommended Posts

Hi everybody. My name is Christina. I am from North Texas. I am 23, happily married for four years and a full-time student about to graduate. I have a seemingly good life, except for the big elephant in the room...which is me. I currently weigh 356 pounds. I have a BMI of I believe 58.1. I decided about 5 months ago to go to a Lap-Band seminar, and met up with "True Results". I have been doing all of my lap-band insurance approval requirements through them. I have Aetna: Open Access. I went through the four-months documented nutrition meetings, chest x-ray, blood work, psychiatric evaluation, sleep apnea test and submitted all the documented "weight history over the past two years" that I could. Here is my problem.

I was denied.

I was denied because I could not prove that I have been morbidly obese for two years. I did not have insurance until about 6 months ago. I did not have insurance between 2008-2010. I found two more records today from 05', and one from 07' from an emergency room. I do not know what to do. I was wondering if anyone had any suggestions? Can I submit pictures with time stamps? I have plenty of those. I would really appreciate all of the advice/help. You are all such wonderful, strong people. I have been reading your boards for months and never had the courage to join and say anything myself.

Has anyone else gone through this? What should I do?

Thank you,

Christina.

Share this post


Link to post
Share on other sites

Usually insurance companies want proof via a doctor that you have been obese for over two years with no way to control your weight. It has to be documented in your chart for two years. If you only have sporadic times you saw a doctor and the ER doesnt count then they may want you to wait two years unless you have severe comorbidities like diabetes or high blood pressure

Share this post


Link to post
Share on other sites

I would imagine the ER records would help... do you have any doctors records from before 2008? I mean I'd assume they realize if you were obese 3 or 4 years ago, you didn't get magically skinny in between then and now... but I'm just guessing.

Share this post


Link to post
Share on other sites

Don't give up, where there is a will there is a way. Quite a few people on this forum were denied and appealed and got the surgery. Hopefully some of them can shed some light on it for you. Good Luck!

Share this post


Link to post
Share on other sites

My insurance company accepted date stamped photos

Share this post


Link to post
Share on other sites

Many insurance companies do accept dated photos. Just keep appealing and get your doctors to help. It is assinine to believe that someone was obese in 2004, 2007, and 2010 but not in between 2007 and 2010. It's not like you're on the border of obesity. You should have a strong case of appeal with pictures and the emergency room data.

Share this post


Link to post
Share on other sites

I did find some records from 2007, and two from 2005. I did also find some pictures. One with a time stamp and one without. I am hoping that this goes through!

Share this post


Link to post
Share on other sites

call the customer service hotline and ask them if they take time/dated photos and if they will take the documents that you do have. prediabetes and hypertension are comorbities, if you have joint problems, this can be considered a comorbidity. Good luck!

Share this post


Link to post
Share on other sites

Just don't give up!!! The insurance company is betting their money that they can wear you down and you'll go away! Keep going!

Share this post


Link to post
Share on other sites

Hi everybody. My name is Christina. I am from North Texas. I am 23, happily married for four years and a full-time student about to graduate. I have a seemingly good life, except for the big elephant in the room...which is me. I currently weigh 356 pounds. I have a BMI of I believe 58.1. I decided about 5 months ago to go to a Lap-Band seminar, and met up with "True Results". I have been doing all of my lap-band insurance approval requirements through them. I have Aetna: Open Access. I went through the four-months documented nutrition meetings, chest x-ray, blood work, psychiatric evaluation, sleep apnea test and submitted all the documented "weight history over the past two years" that I could. Here is my problem.

I was denied.

I was denied because I could not prove that I have been morbidly obese for two years. I did not have insurance until about 6 months ago. I did not have insurance between 2008-2010. I found two more records today from 05', and one from 07' from an emergency room. I do not know what to do. I was wondering if anyone had any suggestions? Can I submit pictures with time stamps? I have plenty of those. I would really appreciate all of the advice/help. You are all such wonderful, strong people. I have been reading your boards for months and never had the courage to join and say anything myself.

Has anyone else gone through this? What should I do?

Thank you,

Christina.

Share this post


Link to post
Share on other sites

did you go to your primary care doctor and ask for copies of your medical visits over the past 2 or 3 years? I had to do this and it was extra hard because my primary care doctor had in fact died so time before and I had to go back to every doctor I had ever seen in the last 5 years and ask for any records they might have on me that showed my weight and the date it was recorded so take a moment and think back on every doctor you ever have seen for any reason in the past few years then call them and ask for copies of all your visits to them that have a date and your weight recorded on them but do not give up it is the insurance companys job to keep expenses down and so they will use every reason no matter how weak to deny you so make sure you know exactly what they require your surgeon should be able to tell you exactly what you have to have documented to get approved then make sure you have it in spades if they want 2 years give them 3 or 4 if they ask for one doctors letter get 2 or 3 and I believe you will be successful.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • Bashbee91

      Hey guys new to the process looking forward to this new life. 
      · 0 replies
      1. This update has no replies.
    • Bugg

      Hi everyone! I’m brand new here. I just went through all my pre-op requirements per my insurance company and now everything has been submitted and I’m just waiting for final approval and my surgery date. I’ve been doing research, watching YouTube videos, TikTok’s, ect.. trying to prepare my mind and what to expect so I’ll be ready for the surgery. I was so sure and so set and so ready and excited. However, now that I’ve done everything & it’s almost here, I am sooooooo scared! I know why I want it bc I’ve tried everything and I just don’t feel like I can lose weight by myself. I’m tired of being overweight my entire life. I’m miserable, but I keep psyching myself out afraid of GERD bc I know how that can be and I don’t want to have to get a bypass after already gaining the courage to even get VSG. I’m scared of complications like I’mgoing to regret doing it and be depressed that I didn’t just be more disciplined and try again to lose the weight on my own even sitting here typing this knowing in my mind i just can’t and don’t possess the discipline. I’m also afraid I won’t be able to handle the restrictions of the sleeve. What do I eat? I don’t know how to eat healthy really and don’t enjoy healthy food. I don’t know how to do this! I feel so defeated!Someone tell me they felt anything similar to this or am I not ready? I thought I was. I am so tired of being sick and tired and so tired of myself and so tired of being stuck and stuck in this body and somebody different on the outside from what I feel inside. I just want to ball up and cry.
      · 0 replies
      1. This update has no replies.
    • buildabetteranna

      over 20 lbs down since4 the pre surgery diet and surgery on the 14th
      · 1 reply
      1. Selina333

        Yay!! Congrats. I know how good that feels. 🤩

    • Jenopolis

      Had a sleeve in 2017, lost over 100 pounds. Had a DS surgery this year (2025) for more sustainable weight loss. 🤞
      · 0 replies
      1. This update has no replies.
    • buildabetteranna

      The 14th was my day. I am home and recovery is going pretty smooth. They even let me walk out of the hospital. Picture of me in recovery curtesy of my boyfriend lol. 

      · 3 replies
      1. DaisyChainOz

        Glad it went well!! Wishing you a speedy recovery and wonderful success!! 🤗

      2. buildabetteranna

        Thank you ❤️

      3. Selina333

        Neat you have a pic of this day! I was sooo happy to get my surgery. It was well worth it! And I'm not even near my goal. I had surgery Dec. 2!

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×