Reached My Breaking Point

[Heyher 581]

Appeal was denied because I don't meet the minimum requirements. Uh duh if I met the minimum requirements there wouldn't be an appeal needed. So did they even look at the letters of medical necessity? Or the diagnosis of sleep apnea? Or did they say nope not fat enough long enough? Why file an appeal if they are just going to say here is our cookie cutter and you don't fit. So you can continue to have your health decline.

Can't self pay because extra money is going to home repairs nd wedding. With my ms I'm wondering if I need to put myself through this much stress. As I type this through tears I'm thinking of just giving up.

[HeyMo35 21]

I'm sorry you are having such a tough time.

I would relax but not give up! I've heard of people appealing ins. multiple times. Also, I would check with you doc office coordinator to see if they have a legal person who can go after the ins co? I know my doc office does...

Dont give up but dont get too stressed out! Where theres a will theres a way!! :ph34r:

[lessofmeismore 1,405]

Hey don't give up! Look at other options; maybe a loan for self pay? Perhaps going out of US where its almost half the cost? Appeal again and again. Don't give up, if your weight is detrimental to your health as mine was, treat it as such, do what you need to do to become healthy.

Hang in there... I'm sorry you're hurting...

[Ruffus 66]

It is a hard process! I was denied the first time... then was given many different options by the coordinator. If I would have been denied the second time they would have done a peer to peer. Another option was talk to the weight loss attorney they use, then given the number to a finance place for medical procedures.

What ever you do don't give up it is worth every tear you cry.

I know this because it took from July till October of this year for my fight!

I was sleeved on Monday and would battle Anthem all over again if I had to!

[michelleooo513 245]

Keep on fighting for yourself and your health! Don't give up. Maybe they'll get tired of the appeals... ya never know. Just hang in there.u didn't come this far for nothing

[kadive 21]

After denied twice from Cigna a received the approval letter today. You have to fight! Important to have your PCP and surgeon on your side. Your PCP can ask for a peer to peer with the insurance to fight this for you. Make sure you submit all the insurance requirements so they don't have an excuse..

Don't give up, you can do this!

God bless

[READY TO LOSE IT 91]

I have been thinking about just this all day. I have completed all my requirements I have my last preop appt Nov 5th and then they can submit to insurance and I just have to wait. I am scared to death they will deny it. I already have surgery date for Nov 20th. I have arranged off work, fmla, made home arrangements..etc etc.. I have planned every I can but they control my fate. Don't give up. I hope and pray I am approved but it not I'm gonna fight!!

[Looking Ahead 239]

Anything worth having isn't given easily. Hang in there and keep appealing !!!

[Heyher 581]

Well on top of multiple sclerosis and sleep apnea they think I may have fibromyalgia. But still not enough for surgery. Going to the doc to talk to them about what my options may be to help with pain...

[KatieOkieDokie 171]

Have you thought about trying to get on disability, or is that Medicare who you're fighting with? Or do you not live in a state that has approved the Sleeve for Medicare? I know Ohio has.

Also is it possible that your doctor will allow you to make payments towards the surgery? And then if your insurance does decide to approve the surgery they can just apply what you had already paid toward the surgery. Also I don't know how much self pay in your area is (here it is between 16,000 - 30,000 depending on where you go). But maybe looking into getting a loan. If you own your house you can refinance, or if you have a 401K you can take a loan out from there (then you'll be paying yourself back).. Or you could hold off until after your married, and if your husband adds you to his plan maybe they will approve you. I know being told to wait for something you want so bad..to make you feel better is hard. You want it now, because you just want to feel better (at least I do). I hope this works out for you.

[Heyher 581]

And.......

Fibromyalgia it is. Start on my med soon to help with pain...

[lessofmeismore 1,405]

How do they diagnose fibromyalgia?

I hope they didn't give you lyrica, I gained almost 40 lbs on that...

So sorry you are hurting

I know the pain of ms flare ups are bad enough.

[Heyher 581]

Spent a good 45 minutes describing area of pain, type of pain, length of pain, intensity, stiffness in muscles ect. Knowing ms and fibro have similar sensations and ms meds don't help pain. They are putting me on meloxicam to help with pain.

It is an NSAID but it is one of the most tolerated. After the sleeve we may need a different type. But I guess a lot of my docs patients with fibro take meloxicam and do very good with it. So I may be able to function this winter. Also found out when appeals are exhausted employer may allow an exception for me.

[lizv123 389]

It is a hard process! I was denied the first time... then was given many different options by the coordinator. If I would have been denied the second time they would have done a peer to peer. Another option was talk to the weight loss attorney they use' date=' then given the number to a finance place for medical procedures.

What ever you do don't give up it is worth every tear you cry.

I know this because it took from July till October of this year for my fight!

I was sleeved on Monday and would battle Anthem all over again if I had to![/quote']

This scares me, I have Anthem and they get my paperwork in little over a week. What reasons did they give you for not qualifying? My heart sank reading this :/

[lizv123 389]

I have been thinking about just this all day. I have completed all my requirements I have my last preop appt Nov 5th and then they can submit to insurance and I just have to wait. I am scared to death they will deny it. I already have surgery date for Nov 20th. I have arranged off work' date=' fmla, made home arrangements..etc etc.. I have planned every I can but they control my fate. Don't give up. I hope and pray I am approved but it not I'm gonna fight!![/quote']

My last pre op appt in November 6th. Same boat :/