It's Like Running In Sand

[MWoods1964 24]

I am really frustrated. It seems like everytime I clear a hurdle toward getting a surgery date something changes. Today I found out my insurance invalidated my 6 months of Pre-Op diet and weight ins with my doctor because I met with the office Physician Assistant once when my doctor wasnt available.

They are now requiring a new 6 consecutive months of doctor visits and weight-ins to be eligible. 6 more co-pays, 2 more sets of 90 day mail-in rx's. Drives me nuts that co-pays don't go toward deductable or there would be some saving grace.

For someone who is diabetic has a BMI of 43 has sleep apnea and HBP I would think the insurance company would be happy at the prospect of getting me off their spending ledger.

Sorry for the vent but I knew you guys would get it.

[jen_1381 446]

Wow that is so frustrating. I'm surprised that they won't accept the visit with the PA. Sorry you have to go through this, again. Did you lose any weight on the 6 month diet?

[MWoods1964 24]

Wow that is so frustrating. I'm surprised that they won't accept the visit with the PA. Sorry you have to go through this' date=' again. Did you lose any weight on the 6 month diet?[/quote']

No when they put me on insulin my blood sugars got better. The more insulin I took the more weight I gained. The more weight I gained the more insulin I required. See where we're going here. I went from 290 to 330 in a year. Again my blood sugars are great but I cant continue on this path. My doc says in some patience the weight gain (fat stores) are greatly increased on insulin. This surgery has the potential to change this by initiating the full feeling early, reducing the food intake and there for reducing the potential for glucose in my system.

I have been on a 2500 and now a 2000 calorie diet and my weight gain has slowed but I am hungry all the time so when I slip and binge its ugly and my sugars go whack-o.

[Holly Dolly 575]

I would def appeal the fact that they aren't counting your weigh in with the PA. Start making some phone calls to your ins company. That just doesn't sound right. I work with ins companies and they deny things all the time until I call and have the claims processed again. I wish you luck!

[jennifer1 180]

that is sooo ridiculous. i would look into that and then make sure before you begin the second time around that there is nothing else they can trip you up on...sounds like they are tryn not to pay for your surgery. ugh! best wishes

[Dulci 108]

I would definately appeal that decision. If that doesn't work, I would hire an attorney. Search on this site, I have seen some people post that they hired a law firm in CA to help them with appeal their insurance denial.

[mandagay 93]

I agree that u should appeal and have them reprocess the claim. I worked as an adjuster for UHC and I can tell u that what isn't processed in India is processed by someone just out of training. The more experienced people handle the reprocesses. Call them and tell them it isn't right and have them reprocess it. Good luck!!