Going Crazy!

[baileymb 0]

I was approved for surgery end of April, things were going along kinda bumpy and now I am at the end only to recieve a call from my surgeon's office stating effective May 1st a new document has to prove at failed attempts at weight loss.

I was just informed that my surgery is no longer covered by my insurance unless my doctor (PCP) writes a letter informing them of my failures at weight loss.

I am now stressing again, angry, confused and annoyed. Has this happened to anyone else out there? Or am I just one of the lucky ones!

Any support would be fantastic right about now!

Thanks for listening as usual!

Baileym

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Lord knows now!

I am praying for 6/21/04 Surg. date!

[Alexandra 55]

Hi Bailey,

This is really a very routine request, and such a letter has probably been in every single one of our files. I mean, why would you even consider weight loss surgery unless previous attempts at weight loss had failed? This is a no-brainer, but the insurance carrier requires your doctor to attest that this is so in your case.

Your PCP should have no problem writing such a letter, assuming it's true and that he supports your desire for WLS. Go ahead and ask him, maybe even draft something he can adapt. Give a general list of what you've tried and summarize the results or lack thereof for each one.

Not to worry, this is routine. You'll get there yet!

[nightingale2u 42]

So sorry Bailey... the process is frustrating but I can say that I was required to list all of the different weight-loss attempts ... how much was lost... how much regained... when and for how long. I gave all of that info to my PCP along with my family health history and he dictated note that included some of the major attempts at weight-loss ... family hx of obesity... health problems related to my obesity as well as his professional opinion that WLS would not be unreasonable in my case and should be considered. Sending you hugs... can just feel your frustration and hope once you gather this info that everything will be back on track!

Darcy

[CandyB 0]

I don't want to sound discouraging but, at our most recent support group meeting, we were informed by the director of our bariatric surgery center that many (most?) insurance companies have begun to require that a WLS candidate must prove that he/she has been on a supervised weight loss program for a duration of at least 6 months sometime within the last 2 years, and either failed to lose weight or to maintain weight loss. Some of the people in our group who are still waiting for a date are scurrying to meet this requirement. I know I couldn't have proven that in my case. One member, who has a borderline BMI is afraid that if she has to go on a diet to meet this requirement and loses weight before her surgery, she will not qualify for the surgery anymore.

[baileymb 0]

Funny thing, fate or coincidence??

I was at my mothers house and was talking to her about how I need to speak to my PCP which we have the same one. And you wanna guess who calls my mom?? That's right our PCP. So I got to speak to her and she said it is not a problem and she can get that letter first thing tomorrow!

How weird is that?

I feel much better, but I can't wait to get that approval AGAIN!!!

I think that anyone who was already approved through the ins. should have never gotten un-approved. I think that really stinks to do that to people....

Thanks for all the support, gotta love this board!

Baileym

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Still hoping for 6/21/04:D

[nightingale2u 42]

That's great Bailey!!! I think you are right... approval should be approval! Sorry that you had to go through a few more hoops but it sounds like it will go pretty quick once they have that letter from you PCP. Let us know what happens!

Darcy

[baileymb 0]

Hi all,

Went again to see the sleep guy, just do not seem to be progressing here. Don't know why!!

I went to my pcp, I have been seeing her for 14 years and have been with that office for 26 years, so she had a lot of past attempts and failures on my weight loss...I hand delivered my letter to the surgeon's office!!

Spoke with Dr. Deol in person today, she has been so great...

She said my letter should be perfect it was just what she was looking for...and wanted to use it as a reference for other patients to use for guidence...

She said of course she would block out the name n stuff. I thought that was fantastic!!

Now that I told everyone, I guess there is no need to block it out! LoL

So right now all is well again!

Thanks again for listening, as I am sure this will not be the last time!

Baileym

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6/21/04 Looking likely

[nightingale2u 42]

So glad to hear that things are back on track for you Bailey!

[birdee 1]

My surgeon required that up front. DON'T worry! I had bumps along the way to. I think that's just fates way of testing us!

You'll be fine!

Birdee

[gretat 0]

Hi Michelle,

Wow, no wonder you have been up and down. What a mess and how stressful. I saw Dr. Deol today (one month post-op) and she said that there was a lot of worry with some patients about the insurance changes. What a bummer. I guess bottom line is that they don't want to pay for surgery. Boy that makes sense, right? In the long run it would be much cheaper to pay for the side effects of diabetes, sleep apnea (at $1,000 a test!) etc. I don't understand their thinking.

I am glad that you are back on track, though!!

As my dad likes to say, "Keep your chin up!"

Greta

[baileymb 0]

Hi everyone,

Thanks for all the + comments it has really helped me throught this pre-test procedures!

I just got a call from my surgeon's office and it looks like my surgery is now June 14th!

Debra if your still on the 14th, we can be buddies! (I hope)

I am so excited, scared, nervous, scared, happy, relieved... did I say scared??

Thanks again for everyone on this board, you have truly been a great asset to my journey!

Baileym

________________

JUNE 14th

Dr. Deol

Way tooo much/------->/Just right

[Vera 7]

I'm so Jazzed for you!

Congratulations

[New Hope 37]

Hang in there! Mine was denied in October, 2003. We jumped through all the hoops. I'm having it done tomorrow, May 26, 2004! This website has given me such great info. and support. Persistence pays off. Best of Luck to you!

[Alexandra 55]

Hey Bailey, that's great news!!! Flag day, huh? A great day to be banded!!

[Debra 0]

Michelle, you got my date!! Glad I could help!!

With all the insurance gumbo I decided to wait 'til July, 'cos I started E-diets in July of last summer, so that gives me 12 consecutive months of charts, etc.

So, July 19th for me.

If I could have given the original date to anyone ... it would have been you!