3Rd Time Isnt A Charm!

[sharonk 23]

I just got denied a 3rd time! I dont know what i want to do at this point. Im angry sad confused! Finally emotionally drained at the thought of appealing on my own behalf, which insurance said i could do.

I called the drs office and told them i would like to come by and pick up all the documents that were submitted. They told me they will have to put everything together and will call me next week when its ready. Wait, why isnt it ready now?! Wth?! Didnt they just resubmit my info this week?!

I dont get it!!

I started at 39 bmi now im 40 bmi so i dont need the comorbids and my dr office states that the 40bmi is what was submitted this past week for the dr on dr review. ive done my 6 months, pysch exam, test, consults. Trust me when i say i have done EVERYTHING my insurance medical policy has stated!! Ive read it a trillion times!!

I cant get an exact answer from insurance rep because the info hasnt been entered into their system yet. So basically im back to waiting and trying to figure out in my head what it could be. Maybe my drs office has something wrong?! I dont know?! They did seem a little weirded out that i was requesting all the paperwork but hey this isnt their life so why would they be as particular with the info, right?!

Any who, im going to TRY not to think about this too much over the weekend maybe a few drinks will help me forget. i think i will review my packet and then decide from there what to do.

Thanks to those out there in band land listening to me vent! I pray others have better luck than me.

[chrissylu 153]

My cousin was denied 4 or 5 times for gastric bypass and she was probably 400+ pounds at the time. She had several health issues, doctors and hospitals submitted on her behalf. She kept appealing (or the doctor did) and she finally got approved. Moral of the story, if you know you meet your insurance company's requirements...don't give up. I will send up a prayer for you on this. God bless!

[BayougirlMrsS 3,934]

oh sweetie.... im so sorry. Really wish i could help. You know i would.

But you made a good point.... why will it take a week when they should have all that together already? That looks like a RED flag to me on your doctors office part.

[sharonk 23]

Thanks chrissylu.

I literally just got a call from my drs office and they discussed my case and are confused at the 3rd denial. Apparently when i called to request all the documents it must have lit a match under their butts.

My dr says that the last he spoke to the insurance dr he was asked to submit a document and did so. He NEVER had an official conversation about my case. So why did the insurance dr deny the appeal is a mystery now to us all.

My dr has agreed to try aonther dr on dr review but he is going to be out of the country till april 1st.

More waiting....but at least they are trying again which they didnt say they were oing to do earlier today

[sharonk 23]

I was thinking the same thing bayou!!!

[chrissylu 153]

You are right...it shouldn't take a week...but maybe it because its Friday, they're trying to get out of the office, maybe they have a long line of medical records requests? who knows? At least they called back and working hard on it again. Sucks that he's going to be out of the country for so long.

[ladyfromirvine 22]

when all else fails you can do what i did.. from decision to surgery was 2 weeks. i was banded in mexico and i am 3 weeks post op. i can't say enough about the facility and the doctors.. the entire procedure, including transportation to and from the us border into mexico and a stay overnight in a 5 star hotel all cost 5K. I figured i'd spend more than that on my car.. so why not on me. the surgery center was spotless, the staff professional and the care wonderful. if i had to wait as long as some people i read about here... i would be collecting social security before i would be approved for surgery.

[sharonk 23]

Yeah, i dont have $5000 much less $1000 to spend. Too many expenses now and with the current economy im not tkaing the chances. Not only that but i dont fly so mexixo is out of the ? for me.

[TracyC 32]

I just emailed my doctors office. They use an attorney out of California to appeal insurance decisions. When insurance denied my surgery, the doctors office contacted the attorney in California and he handled the appeal with very little to no effort on my part. I can't put my finger on the contact information for the attorneys office, hence the email to my doctor. I will forward the information to you once I get it. I hope it helps. The attorney is a former WLS patient himself, so he knows what you are dealing with. I hope the information helps. I'll get it to you as soon as I can. Unfortunately, I just sent the request (4:30 on a Friday) so I probably won't have it until Monday. Try to enjoy the weekend.

[Kristih 2]

What insurance do you have?

[sharonk 23]

Bcbs located in pa

[Kristih 2]

***..OR PPO?...i was also denied...because in my insurance stipulation..i had to be at my current weight/BMI for 3 consecutive years...which to me is horrible..and NOT standard of care. Its very frustrating and emotionally draining..hang in there...because there are alot of options.

[NWgirl 574]

Look into obesitylaw.com. I read a post awhile back from a woman who went through them after she was denied and was ultimately given approval. If you satisfy all requirements set forth by your insurance and they are unable to give you a clear reason why you were denied, consider reporting them to whatever department in your state that oversees insurance matters. If they are setting forth guidelines but not actually following them, it's illegal.

[sharonk 23]

Ppo...i couldnt find any stipulations on their policy but thats not to say it isnt there.

Obesitylaw i believe cost money?! I refuse to pay someone to get me an approval when i know myslef that i have done everything.

Im seriously thinking it may be my drs office who is not submitting the proper paperwork. I will wait till april and go from there. Thanks for all the support it reminds me im not alone!!

[tracysmith 0]

It probably is sitting on a persons desk and they haven't bothered to check it out yet.I think it takes about aa month to clear.