First Denial

[pjlajara 0]

Well today I got my first denial - I am very upset about it. I started this process in January, the paperwork was turned in on April 11. I called Friday (June 1) and it wasn't even in the system yet.

I talked to the place where I am having it done and they said at least I now have a blueprint of what I need. One thing they require is a trial of a behavior modification program - anyone heard of that?

Oh well, I will try to keep my chin up and see if I will have the surgury this year.

[nursekathy2u 0]

What insurance do you have? Who told you it was denied?? I have never heard of a behavior modification program.. I have heard of a diet, exercise and behavior modification program.. Something sounds wierd here to me.. there must be some more specific reason you were denied.

[pjlajara 0]

My insurance is great west - the letter from the insurance company i lacked the following: weight loss ; diet program for at least 6 mths within 2 yrs, monthly clinical from healthcare professional, trial of a behavior modification program, psychologial eval for this type of surgery, endocrine eval for obesity & post operative follow0up plan monthly for 6 months. I did have a psychologial eval for this so don't know what that is about.

[omlagirl 0]

I too have great west and I am waiting to hear if they are going to accept my claim or not. What happened with yours?

[pjlajara 0]

I am making monthly visits to the doctor so they can weight me. I have been 3 times so have 3 months to go. If you have great west, make sure that your request has been entered into the system. One of the problems I had was it sat there for like 3 months, I had to call for them to find it to enter the request into the system.

[omlagirl 0]

Are you having your surgery locally or are you looking into going to Mexico? I think if I get denied by great west I'll be saying "Si" to Mexico.