Denied, fighting depression.

[Ballermom 803]

Have your Surgeon or pcp write a letter of medically necessity. Citing your BMI and all your medical problems each one explaining the weight related problems it is causing. The diets you ve tried. Look on Obesity help . com for a sample letter. Basically proving why you medically need the surgery.

Good luck!

[TheCurvyJones 721]

Even if you don't want to go to Mexico there are surgeons in the US that you can look into. I.e. Dr Umbach in Las Vegas... go when it's cool, take a few days ahead and make a vaca out of with with your hubs. Check out MedicalTourism.com... there are some docs in the US that are self pay. More than Mexico but less than the full cost of a VSG surgery, which is what the insurance covers.

I knew that if my insurance even covered it that I wouldn't ever make it through the 6 month hoop jumping. I'd give up halfway and still be fat at the end of the year. I pushed myself to move past any 'NO' I heard and I made it happen. I was sleeved a week ago w. Dr Alvarez who is AWESOME as is many of the MX surgeons that some of us have visited.

You still have options! Get to work!

[does not matter 39]

It's a long story but a year ago I fell and tore a tendon and bruised an ankle bone. It still hurts, I can't walk more than a few blocks without being in severe pain.

I started researching in February and had the surgeon call UHC. They said I just needed a 5 year history over 40 BMI.

I called twice and was told the same thing.

In the meantime I've gone to seminars, support groups, spent hours and hours online researching. I have never spent so much time on deciding anything.

Finally I decided for sure, went to all the tests. Had to make up all the time off work.

They finally submit and I get a denial because they want me to do a six month diet.

I'm 41, I have done every diet known to man, hypnotherapy, supplements, psychotherapy, and exercise.

I've been told if I don't lose my ankle won't heal. But I can't work out because of the pain.

I'm on an antidepressant that causes weight fIn and makes weught loss almost impossible. I have tried numerous times to get off of it. I even have taken other medication and nothing works.

I am trying to get my WW history but they are playing games with me. I was thinning maybe after surgery I might go back but not now. Because I'm not a current member they won't just print off a receipt. After I went through this a week ago and was emailed my receipts for the online tools only.

Today they say they have to fill out a form to have a department email me my reveille which takes 7 business days.

I feel fat and ugly. I hate my clothes. I have moments when I think I don't want to go on if I can't have the surgery.

I'm thinking I may just end up having it in Mexico.

Trying to keep my head up but I feel so down.

I don't want to go into my whole story since I'm sure many have read it before! However, the quick and dirty... I was told I was the perfect candidate with my bariatric program in my city (I'm in canada tho)... went through all of their tests, had one left (the scope, was waiting for an appointment) and then they kicked me out of the program because they adopted new policies from Edmonton... and guess what!? I no longer qualified after I jumped through all of their hoops for months and months and months, and lost 15-20 pounds by then. I was trying to be the perfect candidate. Their new criteria was 2-3 health related issues and issues with mobility - That was level 2 on their new chart in order to qualify for surgery. I was a 0. They wanted me to do these lifestyle programs, one of which consisted of a 12 weeks opti-fast diet, the other was just seminars. They lied to me for 6 weeks about "not" kicking me out of the program. They said they would re-evaluate me for surgery after one of these programs. I said no you won't because if i don't qualify now, i wont qualify then. Plus is a lost another 10 pounds or so my bmi would fall below 40. They said "yeah, ok you're right!" THEY LIED to me, they LIED to my face for weeks! They got my hopes up and told me I'd be infront of the surgeon in 2 months... then this magical piece of paper showed up and I got the boot. It really threw me for a loop and off track with my diet. I was devastated I was in tears for days. I live alone, have a house and don't have someone to rely on, so paying out of pocket wasn't really something I thought I could do. The states was about $30,000 (a friend went 4 years ago) and I don't have that... I don't even have $1000.... However, in tears I started looking for options (I had no idea about medical tourism). I found info for surgeon in mexico and the rest is history.... I will be going to Puerto Vallarta Mexico on January 19th, Surgery is on the 21st. Honestly... I WISH! I had known about this when I started this process with my bariatric center of CRAP in Feb... it's so much less hassle. I have a Dr who has referred people for years willing to take me on post op, so I have no worries about after care. There is a nutritionist I can pay for who is knowledgable in bariatric if i need it, but i don't see the need with info from my surgeon and tons of info online. My surgery is $6000US, $500 US complication fund, and I used airmiles to pay for my flight, $100 for on extra night in a hotel. I will use my line of credit to pay for my surgery... I can't wait for the rest of my life to start.

Hope this helps, I know there will be people pulling you to do the 6 month diet or the go to Mexico option... only you can make that decision. With proper research you will find some amazing surgeons. It will also be great if you can buddy up with someone if you do choose the mexico option, kind of makes you feel at ease. I have yet to find one, but have spoken to people pre-op and post-op who had my surgeon a few weeks ago and was with them step by step. I have not a single worry about my care while I am there. I am going to Dr Joya in Peurto Vallarta on Jan 21 should you want a sleeve buddy

[kczar 166]

I know it can be frustrating, but you have to fight for this! If you haven't already done so, call your insurance and ask to speak with the bariatric surgery manager. This person will know exactly what you need to do. And if you've gone to your PCP this year (and if he/she is supportive) you can probably get them to fill out the necessary forms. My surgeon had a nutritionist on staff for the first three months of my monitored diet but then she left to have a baby. I just took the forms she was using and started seeing my PCP. Plus he was willing to fill out the form with the date of my physical (where we first discussed the surgery), which shaved a month of the timeline. They do want fairly detailed information. My sheet included the date of the visit, my weight, my typical meal plan (breakfast, lunch and dinner) and what type of exercise I was doing and how often. It also included the doctor's recommendations (avoid sugar, fat, etc.)

I know the "hoops" seem a bit much but you have to understand that the insurance company is going to be paying out tens of thousands of dollars to the surgeon, labs, anesthesiologists and hospitals. My insurance company paid over 20k just to the hospital! They want to make sure that they're not "wasting their money."

Hang in there. You'll get through this.

[Pfabulus 0]

For my 6 months supervised diet, it was go to the dr, get a weight, talk to your dr about loosing weight, maybe even keep a food journal. I would also call to your carrier, with your husband on the line as well, and ask them to send you what their definition of a 6 month diet is. My situation was bit more unique because I had a lap band on 12-31-08, it failed due to irreversible slippage in April 2012. Then I started to check in with the dr every month. I gained over 50# back over those 6 months. Just was sleeved on December 27th.

[greensleeve 457]

They want to be sure they're not wasting their money....I'd like to see scientific proof that people who visit their magic doctor for 6 months have a higher success rate. I highly doubt it.

To me that is what the psych eval and five year history should be for.

It's just a stall tactic. If someone has heart disease and it could get better with diet and exercise, they just do sugery. It seems like more fat discrimination.

[MrsPiggleWiggle 65]

I feel your pain!!!!! I was denied by UHC because I was at a BMI of 39.something over the last 4 years, and only hit a BMI of 40 this year. 39 and change!!!! And they flat out denied the surgery, over what is most likely a shift of about 15 pounds or so. I gave up and am researching Mexico. Already talked to the office of Dr. Ortiz, and am looking at surgery in April.

Hang in there!!!!

[greensleeve 457]

Using this same reasoning....why should insurance pay for addicts to go to rehab? The rates of failure are huge! Should an alcoholic have to go to their doctor once a month for six months to monitor their sobriety? That's crazy.

My insurance pays for cancer patients to have very expensive treatments regardless of how many months they have left to live. why should we pay to get another few months out of someone? See that line of thinking is crazy when it comes to other things but not when you are overweight. Then it's ok.

[greensleeve 457]

I just wanted to say thanks to everyone for your support, advice and thoughts.

I just got back from shopping for pants. I hate shopping. I just really want this nightmare to be over.

[lilricanliz 9]

From someone who did the pre op classes -twice because I was denied the first time due to another health issue, doing those classes help you be successful for the long term. Everyone is different, but I think it would take you that long to get everything straightened out in Mexico w/o having to travel that far. It is your choice, but I just feel you should explore all your options first rather than just throwing in the towel.

[NVTammy 12]

Using this same reasoning....why should insurance pay for addicts to go to rehab? The rates of failure are huge! Should an alcoholic have to go to their doctor once a month for six months to monitor their sobriety? That's crazy.

My insurance pays for cancer patients to have very expensive treatments regardless of how many months they have left to live. why should we pay to get another few months out of someone? See that line of thinking is crazy when it comes to other things but not when you are overweight. Then it's ok.

I'm so sorry you are struggling! I too was denied TWICE! Even with other medical issues it wasn't until my BMI was a 40 for two years- it was 39!

At any rate I kept fighting and having surgery on 1/16/13

My primary doc, my gynecologist and patient advocate were huge help and strong arms!

I know it's not really appropriate, but I wish you wouldn't have compared our weight loss battle to that of a drug addict. I just feel I needed to say this as I thank God every day insurance helped my son, who is alive today. Insurance only covered 1 of his many rehabs - its not what you think. Fighting his addiction along side him for six years made me believe I could fight this battle for myself and I have and I AM!

You will do this. You will be heAlthy and happy. Don't give up. You keep fighting and you will soon see the power that you hold inside- dont let insurance or anything stand in your way!! It may take longer than you hope, but YOU CAN DO IT!!

Keep us posted and you will be in my prayers.

Sent from my iPhone using VST

[Pfabulus 0]

The reason that most insurance companies want you to do a physician supervised diet for 6 months is to make COMPLETELY sure that you want to do this. If you are serious, and fly through their requirements then you will be fine. Every insurance company/employer does it different. It depends on how much the employer wants to include on their plans, which drives the employers costs up or down, the same as your out of pocket costs up or down. I sincerely doubt that they do this to increase pain and frustration. Remember there is admin costs on their end as well. And with the Affordable Care Act only 20-25 cents for each premium dollar can go towards administrative costs at the insurer level. I think it would be worst if it was a simple process, then you will have lots of people having some type of weight loss procedure, then sueing as they had no idea what they were getting in to. I also do not feel you can compare this with drug or alcohol rehab, that is comparing apples to oranges. I work for a health insurance company and had to do the 6 month physician diet, even after having to have my lap band removed due to slippage/failure. I had to jump thru every hoop to get my sleeve down, just a couple of days ago.

[Ballermom 803]

. You keep fighting and you will soon see the power that you hold inside- dont let insurance or anything stand in your way!! It may take longer than you hope, but YOU CAN DO IT!!

Keep us posted and you will be in my prayers.

Sent from my iPhone using VST

Keep your head up!

[Velena 122]

I have UHC also, BMI was above 40 and I had co-morbidities of diabetes, high blood pressure and high cholesterol. I didn't have to do the 6 months of diet with my PCP, but they wanted proof that my BMI has been over 40 for the past 5 years. I got the copies from my Doctor's office and my PCP wrote a letter stating why it was medically necessary. Keep calling the insurance company. If someone can't tell you what your policy covers, ask to talk to their supervisor. Keep pushing them to tell you everything you need to do and ask for it in writing. Make them send it to you or the bariatric doc in writing. You've been paying for this insurance for years and UHC covers the Vertical Sleeve - make them work for you! You can do this. Good luck and keep us informed please.

[greensleeve 457]

Please don't take offense at the addiction comments. My grandfather was a severe alcoholic who was in and out of rehab at least eight times and got DWIs, was blacking out and had liver and brain damage.

I am just so angry that I wasted 10 months when they could have told me this at the beginning! If it's only a waiting period, I have proof that I went to the seminar in February, that I've been to two support group meetings since then.

I'm just so devastated and I'm trying so hard not to be a negative b&tch in my real life. This feels like a safe place to vent.