New and ANNOYED

[Jessiegurl2686 104]

Hey guys new to this forum!!!! So I've been dealing with this process since June 2012.... I'm 26 years old, 5'5 weigh 217. I've had a hell of a time getting all the correct info from my coordinator which finally quit or got fired. So I got denied last month because I never did my 6 month diet and did not enroll into the biriatric program.... So I was like allright should be easy to complete right! So I had my pcp sign a form with complete 6 month diet info. And then tried to enroll in program. So gave them all my info and they said there nurses are 2 weeks behind but someone WILL call me. Waited for a month and called them come to find out they UN enrolled me because now I need TWO cormorbites..... I was never told any of this info since June . And they could have called and told me i was UN enrolled. I have diabetes did my 6 month diet ... sleep study and saw the phyco. So my next step is getting a attorney to appeal for me. Has anyone been though this before?!!

[AmandaRaeLeo 2,146]

WLS is completely excluded from my insurance. Period. No exceptions. So I'm a self pay and I'm going to Mexico in March.

Amanda Rae

[Jessiegurl2686 104]

What gets me I've had same insurance for 6 years.... Never had any surgreys .... Hardly went to dr. And the one time I need something for them they make it the hardest thing to get accomplished. There is always something . I think when I get my income tax I'm going to get an attorney to appeal it for me..... They have been doing this for 17 years and they said I would be a good candidate..... Ughhh just want this sooooo bad. I already told myself I was getting it. Now I'm like so upset they crushed my dream.

[AmandaRaeLeo 2,146]

What gets me I've had same insurance for 6 years.... Never had any surgreys .... Hardly went to dr. And the one time I need something for them they make it the hardest thing to get accomplished. There is always something . I think when I get my income tax I'm going to get an attorney to appeal it for me..... They have been doing this for 17 years and they said I would be a good candidate..... Ughhh just want this sooooo bad. I already told myself I was getting it. Now I'm like so upset they crushed my dream.

Gotta love insurance companies. *sarcasm*

Amanda Rae

[lovietobeme 45]

Who do you have insurance through if you don't mind me asking?

[Jessiegurl2686 104]

United healthcare

[JennyBeth 127]

It sounds like your issue lies mostly with the surgeon's office rather than the insurance. Although if their requirements are 2 co-morbitiies and you only have 1 then you won't qualify no matter what you try and do. Did the insurance un-enroll you from the bariatric program or did the insurance? Insurance companies will try and make it as difficult as possible so that you get frustrated and walk away. I have always thought that the surgeon and their insurance coordinator are the ones that help you to appeal the insurance's decision or your PCP. If the doctor is telling you to use an attorney then to me that should be a red flag to find a new surgeon because they should do the work to get you approved-after all they are the ones that will be getting paid.

[SoCalDixieGal 172]

I'm insured through them as well. I know they vary though around the country. I called them some time ago about what their policy was on WLS. Yeah, the 35-40 BMI needed 2 co-morbidities, which I dont' have so then it's all cash.

Considering how much money you'd spend on the attny, you might want to research the Mexico route. I initally didn't think I'd ever do that, but the difference in $ was enough to get me researching.

[Jessiegurl2686 104]

Thanks girls! In just getting frustrated with this whole thing. Got my hopes up for nothing . I had a friend go through this same weight and everything but I guess her insurance wasn't as strict . And she had no cormorbities ..... So should I call my surgeons office and ask them why I need an attorney and ask if they can appeal it???

[Mastiff_mama 171]

Jessie have you researched comorbitities? I think there are several...sleep apnea? Did you have any?

[Mastiff_mama 171]

How about GERD? PCOS? Fatty liver? I am sure they can find another one!

[Jessiegurl2686 104]

I already did a sleep study and it was negative . As of right now just medicated pre diabetes ..... They said I would need high blood pressure ...High cholesterol or sleep apnea

[tessies 224]

Thanks girls! In just getting frustrated with this whole thing. Got my hopes up for nothing . I had a friend go through this same weight and everything but I guess her insurance wasn't as strict . And she had no cormorbities ..... So should I call my surgeons office and ask them why I need an attorney and ask if they can appeal it???

I guess I'm confused. Why would you need an attorney to appeal? Seems like a waste of money. I would head to Mexico before I did that. That's what I'm doing. Not wasting another moment on the insurance BS!

[Jessiegurl2686 104]

My surgeon referred me to the attorney.... That's what that office does.... Appeals against weight loss surgreys..... Kelly lindstrom out of California....

[Geminidrive 389]

When starting with this process the best thing you can do is research and be informed, one call to your insurance company and you would have been armed with the insurance requirements before any doctors visits. If you don't meet the requirements what are they (Surgeon) suggesting that the attys will be able to

do?