Got The Wind Knocked Our Of My Sails :-(

[jgarland 4]

I got a surgery date and now the insurance company said no. What.!? Not medically necessary? I don't understand this at all diabetes, weight related early onset arthritis high cholesterol the list goes on . I had tohave a hysterectomy in 2004 because pcos was so severe so no kids for me and lord knows i desired them then had to have gallbladder removed in 2007. i have spent thousands on diets and exercise programs and doctors all i want is help a tool (surgery) so i can maintain a normal healthy weight for me so i can live a better life.. I know skinny people get some of these same health problems but as we all know being obese is a death sentence in and of it self tack on the extras and what chance do we have aaaaaaaaerrrrrrrhhhhhhgggggg!!!!!

But i will keep fighting think positively for me would you all?

[TinyMamiOf3kids 1,280]

I got a surgery date and now the insurance company said no. What.!? Not medically necessary? I don't understand this at all diabetes' date=' weight related early onset arthritis high cholesterol the list goes on . I had tohave a hysterectomy in 2004 because pcos was so severe so no kids for me and lord knows i desired them then had to have gallbladder removed in 2007. i have spent thousands on diets and exercise programs and doctors all i want is help a tool (surgery) so i can maintain a normal healthy weight for me so i can live a better life.. I know skinny people get some of these same health problems but as we all know being obese is a death sentence in and of it self tack on the extras and what chance do we have aaaaaaaaerrrrrrrhhhhhhgggggg!!!!!

But i will keep fighting think positively for me would you all?[/quote']

Wishing you the best & hope the insurance makes an exception.

[jgarland 4]

I have been sitting on pins since i heard they said no, meeting with my pcp Monday to file appeal

[KevinsBabyGirl85 364]

Crossing my fingers for you!

[lynn 49]

Praying for u and hope the appeal works out

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[jgarland 4]

Thanks it means alot.

[LosingItForMe2011 320]

jgarland...the reason "not medically necessary" just means they didn't receive all the information they wanted the first time. I was denied as well for the same reason but, there are "specific" reasons. I've been denied twice....first time was because they didn't think I'd been under the bariatric center's care long enough. Three months was their requirement. My surgeon proved that and they passed that but, then denied me for the next things they wanted. This time they said the same 3 month thing which my surgeon argued they approved last time so they said they wanted a new letter. They also wanted a new letter from my surgeon that explains all about the surgery again but, with CPT (procedure) codes. (If you're not familiar with medical billing...it's the numbers used for each procedure billed.) She was going to write that over again but, they also wanted a NEW letter from my PCP that actually has the words "medically released for surgery". She had written a letter stating I'm a long standing patient who's suffered from morbid obesity the whole time and that I would benefit from Gastric Bypass surgery. Apparently she needed the extra words. Problem was she was on vacation and wouldn't be back until AFTER my first surgery date. So now I"m waiting to see her this coming FRiday, get a new letter and we can apply for the surgery again which is set for 7/11. Hopefully it will be Medically Necessary again.

INsurance companies use that as a catch all when they want additional information. If it were truly not medically necessary then there will be no other requires being asked of you or your surgeon and they've seen all the evidence they want. Even then you can appeal. IF YOU call your insurance company it does help push it a bit too. Good luck! Again remember this doesn't mean a permanent NO yet.

[jgarland 4]

Thanks, sorry to hear about your woes too. i appreciate the encouragement. The letter i got says they recommend i submit additional information to get approval. guess its time to cross t's and x i's

[lorid 13]

I got all my dates before the approval. I was afraid of getting my hopes up. My husband wanted me to call every week for the status luckily it didn't come to that. I was approved last week!! I've been doing slim fast but I'm anxious to know what/if there is a pre-op diet.

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