Denied!

[faithmd 14]

I was just DENIED!!!!!! I didn't lose the 5% of my excess weight as required by my insurance company during my 12 month MD supervised diet program.

I had a heart problem in the late summer (since been fixed) and went on a medication for five months that made me totally sedentary. I didn't want to do a stinking thing! And I gained 27lbs on it.

My high was 371, my starting weight (the one they use) was 344. So in order to qualify, I have to be 335. Granted I've lost weight since being fixed in December (I'm now 347.6), but even with a letter from my doctor stating that the weight gain wasn't totally my fault, and even with my case manager pleading my case to the medical director for the Ins Co. I'm denied!

I can try again next month...

One positive thing, once it was submitted it only took a couple of hours...

[waterlily1072 5]

I didnt' deal with an insurance company but isn't it standard to deny the first application. I think many of them require an appeal or two to actually approve the procedure. Either way, just keep trying to jump through their hoops it will happen eventually

[faithmd 14]

We (the surgeon's office, my PCP and my insurance company's case manager) were so sure I'd be approved. We worked very hard to have everything lined up, and we did. But I had V-Tach and had to be sedentary for five months.

My case manager said that as long as everything was met, she's had many approved the first time around. So I guess I was really counting on it.

I guess it would make life easier to BA even smaller for OR, but DAMMIT! I've been working so hard already, I want the band to be that extra tool...

Maybe I just need to do Optifast now...grrrrrr!

Thanks for your encouragement, waterlily! I think you're right, I know lots of folks get denied the first time.

[ReneBean 3]

I had to fight them for four months - and finally won on appeal when I took them to the State Insurance Board level...

Fight them. The Heart problem is just that much more reason why you need the darned surgery.

Insurance companies suck.

Fight!

[Iluvharleys 15]

"Good things come to those that wait", hand in there, your day will come!

[faithmd 14]

Thanks everyone. I am feeling pretty (momentarily) defeated right now. But amazingly I think I've had a pre-band NSV of sorts...I haven't picked up a fork or a spoon and shoveled anything into my mouth that I shouldn't have. I'm getting MAD.

Now, how to get another 15lbs off in three weeks... (my next PCP appt is 4/25)

[juliegeraci 7]

Keep up the faith and keep working at it. The weight will come off! Julie

[piercedqt78 658]

I was denied 3 times, in 6 months. Keep after them, it will happen for you. Look at it this way, they are giving you a set reason for denial. I was denied with the ins company saying the band was experimental. I had to change the companies policy, you just need to fit into the criteria.....~Mandy

[Josette 2]

Optifast would probably get you down quick. if not eat lots of protien, no carbs. No sugar! Don't drink anything that has calories. No pop, no juice

[piercedqt78 658]

I lost a bunch of weight on the gall bladder diet. Bland chicken, steamed veggies and buckets of Water. ~Mandy