Scared I will be denied by insurance!

[notjustanotherdiet 1]

I am waiting for my denial! I know I am not thinking positively but I can't help it. I feel stupid and like such a failure. I have not always been this overweight and am so mad at myself for letting this get so out of hand. My BMI is 35, which with my sleep apnea dx I qualify. I know for some of you this sounds stupid but I have tried everything and all I want is to be able to run again. I am a nurse so I know all the risks, the pros and cons, and that I barely qualify. It seems like such a large hurdle to get back to my weight before motherhood overtook everything in my life. I swore I would never let raising my kids get in the way of being true to myself but it did. Water under the bridge. But two years ago right after my last one left the proverbial nest I decided I wanted to start working on my bucket list. Number one run and finish the Marine Marathon. So I started running, problem is that over the years my asthma apparently loved not running! So for two years I tried to train and my asthma became a big barrier. Not just that but also my weight! Don't get me wrong I have NEVER been a fast runner but I had stobborness and endurance. Not any more! I am so scared that nothing will work and I will never be able to achieve this goal. This surgery is merely a tool to get to the goal, but I am so scared that the insurance will look at my file and see that I have not been at this weight for a long time and deny me. It is so sad for the first time in my life it is not about a number on the scale, its so much more. Believe me when I say I have yo-yoed my life the worst was last year on Phentermine. Being on was great going off of it was hitting rock bottom! Thanks for listening!

[alwaysvegas 702]

I was expecting a denial also due to weight history, but I was ultimately approved on the first go!

If you've gone over your insurance company's requirements and you have met all those requirements, then your surgeon's office will have put together a very comprehensive package for the insurance company.

Insurance companies vary of course, but most everyone on these forums has said that if you meet all the insurance requirements and the surgeon's office provides all the required documentation, approval comes through within two weeks.

Best of luck to you!

[Jersrose43 837]

I see on your other post you have Cigna. With a 35 and sleep apnea that is one piece of the hurdle

You need 3 visits to a nutritionist in 89 days or more

You need a letter from another doctor not your surgeon recommending the surgey.

Here is the policy in writing. Make sure you understand you meet each piece and you'll be covered

Good luck

https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

[BitterSweet* 835]

Where there is a will, there is a way. Denial from insurance or not, if this is what you have decided to do there are alternatives; self-pay stateside or MX, financing etc.... Turn your fears into a plan B, whether that is appealing a denial or coming up with an alternative. Hang in there!

[sunshine1234 7]

I am just starting down the same road as you are. Presentation on Tuesday and then I can schedule my first Dr's apt. I know I am borderline and its frustrating. Not "big" enough and not "ill" enough but the writing is on the wall.

[cdenney123 103]

I was denied the first time and was devistated dont give up if you are its a process. Im 30 pounds down in 4 weeks and am so happy I stayed strong and continued the process. I never wanted to be over weight either it was a battle I was dealing with since I was a kid and now at 34 Im finally making the change to become healther and happier. Good Luck

[sunshine210 13]

Your post is me! I'm 35 bmi and used to be a marathon runner before kids and I also just want to be able to run and feel like myself again. I've tried everything to lose the weight too but it always creeps back on. Diet after diet after diet. This was really my last resort but I feel it's the only way I'll have success. I was denied by insurance last Wednesday with sleep apnea because its moderate and they wanted severe but my surgeon was able to appeal with the fact that my blood pressure has also been elevated recently and on Friday I was approved! Whew, yeah I think I was right on the borderline and was sweating it out waiting to see if the denial would be reversed. Wishing you success bc I can SO relate.

[dashofsunshine 875]

I knew my insurance didn't cover it (my insurance is through my husband's work and they just don't include it - simple as that), but I tried anyway and of course, got denied. They told me that I could try to pay more for a different plan, but even then, I had to have been morbidly obese for 5+ years (apparently that is standard for BCBS TN across the board?) I have been overweight all my life, obese for about 5 years, but only MORBIDLY obese for 2 years. My BMI is 49. I guess they just want you to wait until you keel over from heart disease and diabetes before they will cover it ???? anyway, I chose to self pay. It is a lot of money, but I would rather get it now while I'm young and have no co-morbidities than wait 3 more years and gain another 100 lbs and diabetes and THEN have it....there is nothing in this world better to spend your money on than your health. Good luck!!! ????