upset...insurance denied

[mama angela 22]

Hi..I'm so upset and frustrated. I did my 6 months supervised diet and everything...my paperwork went in first of may and insurance denied Romney the 15th. Said I didn't do a doctor supervised diet. I met with my doc...she approved and then I met with a team.nurse..nutritionist ..pt...for 6 months. My doc called and did a peer to peer review with insurance yesterday and they denied again.. my doc said I can start over...meet her and the team once a month for six months... ughhh...I can not take that much time off work again for the next 6 months. I'm really sad...I so need this....sorry for whining

[2muchfun 8,927]

Have your attorney contact them. Bastards!

[MiniMi 1,468]

Hi..I'm so upset and frustrated. I did my 6 months supervised diet and everything...my paperwork went in first of may and insurance denied Romney the 15th. Said I didn't do a doctor supervised diet. I met with my doc...she approved and then I met with a team.nurse..nutritionist ..pt...for 6 months. My doc called and did a peer to peer review with insurance yesterday and they denied again.. my doc said I can start over...meet her and the team once a month for six months... ughhh...I can not take that much time off work again for the next 6 months. I'm really sad...I so need this....sorry for whining

Does your company use an insurance broker? I'd find out who they are end explain the situation and see what they can do to help you. Our company uses a rocker for our health insurance. When I had a problem for something non band related I called them and explained my situation. They then called the insurance and were like an advocate for me and got their decision reversed. It's a good start and a good resource to use if it is available to you. Worth checking out before spending money on an attorney.

[mama angela 22]

Thanks! The nurse here at work wants me to file and expideted (Sp?!) appeal. She said I need to get hold of the doctor and the team (nurse, nutritionist and physical therapist) and have a copy of all their files and then resubmit with the appeal. I'm going to see if I can get all that paperwork together and try that.

I'm told we have an insurance liasion - so if the appeal doesn't work I can try that. I can't believe what a hassle this is. I am WAY overweight...have been for years. I've tried Weight Watchers, Atkins, South Beach, Diet pills, Medifast, HCG...you name it. I also have high blood pressure, sleep apnea, high cholesterol, and type 2 diabetics.....arthritis in my knees...etc. You would think insurance would do anything possible to help me get this weight off.

[MiniMi 1,468]

Thanks! The nurse here at work wants me to file and expideted (Sp?!) appeal. She said I need to get hold of the doctor and the team (nurse' date=' nutritionist and physical therapist) and have a copy of all their files and then resubmit with the appeal. I'm going to see if I can get all that paperwork together and try that.

I'm told we have an insurance liasion - so if the appeal doesn't work I can try that. I can't believe what a hassle this is. I am WAY overweight...have been for years. I've tried Weight Watchers, Atkins, South Beach, Diet pills, Medifast, HCG...you name it. I also have high blood pressure, sleep apnea, high cholesterol, and type 2 diabetics.....arthritis in my knees...etc. You would think insurance would do anything possible to help me get this weight off.[/quote']

There must be something in the files that are not documented right. Your appeal and the liaison should be a great help! Keep the faith!

[KAATNS 1,473]

Appeal right away.

[mama angela 22]

thanks....I just received all the weight management teams notes, the doctors referral.... It looks like insurance is saying that I had to meet with the doctor everyone of those 6 months. I met with her initially and she referred me to the weight management team - whom I met with. I just got off the phone with my doctors office and they are saying that insurance will not budge - that I will have to start over and meet with my doc each month and the weight management team.

[kazjim98 618]

So sorry this is happening to you. The surgeons office should have known that you had to meet with a doctor, it's widely known that insurance requires a doctors visit and not a nurse for the weight loss appointments. I had to do the 6 months and they stressed that I had to see a doctor...I really feel for you, you did what you were told but the surgeons office should know better...Best Wishes

[mama angela 22]

I am so mad at the weight loss team! grrrr....I kept asking "are you sure I don't need to meet with my doctor too?" and they saying no, since she referred me and that this is how they have done it in the past....

8-( Man....I so wanted to have this done by now...

[labwalker 1,177]

If the NUT is on his staff, even as a contract employee, it should be valid. It sounds like your insurance company is trying to weasel out of paying. I'd fight this tooth and nail, and the people on your doctor's billing dept. who deal with insurance claims should be stepping up to help you win this appeal. With your health problems this denial is criminal.

[kazjim98 618]

My insurance specifically states that a physician must be seen once a month for 6 consecutive months and a nut or a nurse will not be excepted. I have to assume that your insurance also requires this, given the reason for your denial, if that is in fact the case, the weight loss team are at fault because they should know this information...I wouldn't give up either, I would start my 6 months over and in the mean time fight any way you can...I'm so sorry Mama Angela...I wish you luck...

[mama angela 22]

Thanks. The nutritionist and physical therapist are on contract with the doctors office. I work a lot of 12 hour days...5 days a week. Right now I can't juggle my job around taking time off every month for another 6 months to go to doc/nutritionist meetings... It was hard to get that approval the first time from work.....

[tess1964 3]

I am having trouble with my insurance. I have completed everything required and have been submitted to my insurance. Now my insurance is changing and they said hey do not cover weight loss surgery in any way, shape or form. They treat all co-morbids but not underlying cause. Anyone successful in getting surgery covered under these conditions?

[deleteme 176]

My insurance won't pay at all. I and to do 12 months of a medically supervised weightless program and if I lost 5 lbs or more over the year it is considered a success and therefore the band won't be covered. So, I ended up paying out of pocket through True Results.

[Gardnergirl2 96]

If you have a benefits advocate or liaison, do at least talk with that person. They may be able to help ( I am an advocate with a major corporation ). I would do that before giving up.