I was denied!

[michellew1 72]

I am so upset right now. I was looking at October 14th as my surgery day. All I was waiting for was final approval from my insurance company. I received the call today saying that I was denied. My insurance company required 6 months of nutritional visits. Back in March, I gained 2 lbs but then steadily after that lost 19 lbs. But because of the 2 lbs that I had gained 6 months ago, they denied me. I wanted this so bad. I needed this so bad.

[KSTUZ 438]

I was denied for almost the same reason and cause i don't have a 2013 weight. I hired lindstrom obesity advocacy to help me after my first appeal and was denied again. I feel your pain. Hang in there and keep fighting. I'm trying to take my own advice too

[Jenn B. 4]

What insurance company keeps denying you?

[brown eyed gal 59]

Dang! That's just not right! I'm sorry.

[michellew1 72]

I have Aetna

[WL WARRIOR 692]

Did you get turned down for not completing the nutritional.visits? Getting turned down for gaining two pounds back in March makes absolutely no sense. I gain 5 pounds of Water weight each month when I get my period.

[brown eyed gal 59]

Crap! I have Aetna. My plan calls for a 3 month supervised diet (I weigh in 4 times, the last being Sept. 12th) I lost 6 pounds the first month, remained the same the 2nd month, and hope I'm down next Friday. That really scares me, I hope by not losing between my second and third weigh in's doesn't keep me from being approved. What will really stink is that I had my shoes off the first two times and the third time I left them on to give me some wiggle room for this last weight in.

I'm really sorry that's completely crazy that you've lost that weight and you were not approved!

[michellew1 72]

Did you get turned down for not completing the nutritional.visits? Getting turned down for gaining two pounds back in March makes absolutely no sense. I gain 5 pounds of Water weight each month when I get my period.

[michellew1 72]

I thought the same thing. Insane!! But yes I gained 2 lbs and got denied. The insurance company was very rude and said that there was no excuse for that.

[michellew1 72]

Crap! I have Aetna. My plan calls for a 3 month supervised diet (I weigh in 4 times, the last being Sept. 12th) I lost 6 pounds the first month, remained the same the 2nd month, and hope I'm down next Friday. That really scares me, I hope by not losing between my second and third weigh in's doesn't keep me from being approved. What will really stink is that I had my shoes off the first two times and the third time I left them on to give me some wiggle room for this last weight in.

I'm really sorry that's completely crazy that you've lost that weight and you were not approved!

The funny thing is while I was doing my visits I asked her several times about weight loss. And she kept telling me not to worry about weight loss. That I need to learn and practice how to eat after surgery. That was what our visits were about. Not loosing weight. That's what the surgery is for. That's why I am doing this, to help me lose this extra weight.

[fitbefore30 32]

Crap! I have Aetna. My plan calls for a 3 month supervised diet (I weigh in 4 times, the last being Sept. 12th) I lost 6 pounds the first month, remained the same the 2nd month, and hope I'm down next Friday. That really scares me, I hope by not losing between my second and third weigh in's doesn't keep me from being approved. What will really stink is that I had my shoes off the first two times and the third time I left them on to give me some wiggle room for this last weight in.

I'm really sorry that's completely crazy that you've lost that weight and you were not approved!

Aetna policy says you cannot gain anything from your first weigh in. That's what my doctors office told me.

Before my appointments I would go on a strict diet with Isopure Protein drinks and might sound bad but I would take a laxative before appt. It will clean you out and if you are backed up lose a pound or 2.

Good luck!

[michellew1 72]

Aetna policy says you cannot gain anything from your first weigh in. That's what my doctors office told me.

Before my appointments I would go on a strict diet with Isopure Protein drinks and might sound bad but I would take a laxative before appt. It will clean you out and if you are backed up lose a pound or 2.

Good luck!

Thanks for the advice. I will definitely be doing that.

[mitzie46 116]

What does your surgeon's office say? That doesn't make sense. You demonstrated you can follow the plan. I would not have needed the surgery if I could have steadily lost weight. Is there an appeal process?

[WL WARRIOR 692]

I would fight this with all you got. Try to get a letter from your bariatritian, nutritional consultant, or even the nurse you were speaking about. The letters should mention their professional opinion concerning whether losing 2 pounds would actually, in any way, foretell your future failure after surgery.

If anything, the fact that you lost weight during pre-op should help you get approved. It shows that you are more likely to be successful losing weight after surgery. Successful weight loss after surgery will save your insurance company money in the long run. Your chances for diabetes, hypertension, and high cholesterol will lesson or diminish. That means less trips to the doctor and less medication. This will help insurance companies make more money. Am I wrong about this?

After you send in the letters to your insurance company, keep up on the status of your case. I mean really nag and call 1-2 times a week. Document when you called, who you talked to, and what was said. Don't give up. Talk to someone else that was approved for surgery through your same insurance company and get some advice on the best tactics that will work.

[Lorraine M 0]

I have Aetna as well. During my consultation visit the nurse told me 3 times that if I gain an ounce at all during any weigh-ins at their office I would be denied by Aetna. I would do low carb, high Protein for a week or two before each weigh-in to make sure I was down.

The only time I was worried is when my final nutrition class was on a Tuesday and my follow-up with the surgeon was on a Thursday. I had to maintain or be lower than the Tuesday weight for my visit on Thursday (2 days later) so I kept it light Wed and didn't eat or drink before the Thurs appt to be safe.