hit like a ton of bricks...DENIED!

[Anxious2beme 93]

I am beyond upset to get that call yesterday. After 2.5 weeks of waiting for an answer, I was denied for failure to provide medical documentation; however, my Drs office supplied 26 pages. I called the insurance and explained how I called, called again and recalled to triple check what I needed to do with their requirements and I did every one of them. Long story short, they had the insurance rep pull the correspondence and she called me within 15 minutes. I put her on a 3 way call with my MDs office and had the letter of denial faxed and the phone number was given for a peer to peer review, which will involve the surgeon speaking to the physician of the insurance company. Don't know how much more of this I can withstand without getting sick over it. Today I woke up with some sort of rash/bumps now on part of my body that's itchy. I'm thinking I may have hives ????

[Madtownsunshine17 42]

@@Anxious2beme - So Sorry you have to go through this. It is very hard to imagine doing pre-op work and then getting denied. I hope it was due to an easily fixable loophole.

[Daisee68 2,493]

Yep that is hives. Deep breath. Hives are awful and a sure sign of stress. Try some benedryl and go to sleep. It will look brighter in the morning. The peer to peer will likely take care of it quickly - especially if it is just over documentation which was provided. Cigna denied my sleep study because it wasn't "medically necessary" and had to do a peer to peer and subsequently agreed that. Then they agreed my actual surgery in less than 24 business hours (submitted on Friday at noon and approved Monday morning). They never even asked more questions or blinked.

[Anxious2beme 93]

Thank you for the positive thoughts, I am trying to remain optimistic. I too think the surgeon will be able to clear this up, but you never know. BCBS told me that "it's rare, dear, to get an approval for bariatric surgery on the first try". That's what she told me. My MDs office wants me to keep my appt on Thursday with the MD and keep moving forward. I'm hoping I can have happy tears the next time I post ????

[The Candidate 3,215]

I wishing you the best for a positive outcome!

[Anxious2beme 93]

Thank you @thePostOp. Means a lot ????

[LoggedOutForGood 233]

@@Anxious2beme So sorry for the hoops you're having to jump through but please try not to let it stress you out!

Give yourself some relaxation time and think positive thoughts! We're all rooting for you and for good things to come. Keep your head up! xo

[Anxious2beme 93]

@ - thank you so much how are you doing/feeling? I hope much better as the days pass.

My MD insurance coordinator just called to say she's scheduling this peer to peer tomorrow as she wants this done asap. she said my insurance says my BMI is pretty low, but even though I make the requirements, she's being a tough one. She asked if I could help support ammunition with my weight loss attempts. I have the previous MD I saw who placed me on Qsymia earlier this year faxing over my dates and weight to her now as well as Jenny Craig from August last year thru the end of the year and how it shows I weighed even more and slowly lost some but still at a higher BMI. Hope it helps when he speaks to them. Thanks again for the kind words.

[LoggedOutForGood 233]

@@Anxious2beme I'm not really feeling any better. The left side pain is excruciating and agonizing. I called and spoke to my Bariatric RN who told me this was completely normal and suggested I use OTC Tylenol until I see my surgeon for a refill for a strong pain med (which is tomorrow). OTC Tylenol is a joke though so I don't even bother. LOL

I know it'll pass and I will just continue to rest and relax until it starts to subside so I can start excercising and working out and getting on with my journey!

Thank you for asking!!

I'm wishing you the best of luck with the P2P review! Please keep us all posted as I know we're all on your side!

[Anxious2beme 93]

@ .... I am so sorry to hear you are still in so much pain ????. Do you still have that drain in or did you even receive one? Just curious because a friend of mine did and she was in horrible pain because of that tube, it was pressing on her lung - as soon as they took it out - wa-la she was a world better. How is your eating going? Or should I say drinking...what are you able to keep down now?

Thank you so much for the well wishes...I'm hoping all works out and is in my favor. I have had a road of diet battle all my life and know that I too deserve a chance to have a healthy and normal life. I will do whatever it takes to make this happen. Fingers crossed.

[Ashlegal 525]

@ Oh you poor girl! Yeah that left side pain is no freaking joke. I am sorry to hear yours hasn't subsided.

I was post-op one week yesterday and have very little pain. I was so excited the morning I woke up and could roll out of bed without waking the entire house up in "owwwww!!!!" howl.

What is on your diet? It is nice to be in communication with someone that had surgery close to mine. Everything will get better in time.

@@Anxious2beme I was denied the first time for the same reason. It felt like they (the insurance company) was deliberately making me jump through hoops I couldn't fit through. I hate it but I will tell you, it all did work out in the end. Hang in there, don't give up and don't let it get you down. Your new life is worth the fight!

[LoggedOutForGood 233]

@@Anxious2beme No, I did not have a drain. The left incision is where all of the "magic happened", so to speak, so its going to be a lot more tender and sore than the other incisions. My Bariatric nurse told me some people don't deal with severe pain and some people do. I am the latter, unfortunately. The past couple of days it has been lightening up a bit, but I'm still having a hard time moving, getting up or down, etc. I know it'll pass, I just need it to pass quickly so I can move forward. I'm in the soft/very mush phase and am holding down everything I've tried. Refried Beans, cheese, scrambled eggs, cottage cheese, etc. Tonight I'm going to try a small dollup of instant mashed potatoes and some chicken salad. Last night I tried pintos & cheese from Taco Bell and they were HEAVEN and full of protein!

@@Ashlegal Hey girl! I am so glad to hear that your left side pain is subsiding! I wish I could say the same I am going to see my surgeon today though and I'm going to talk to him about it. Maybe ask for a mild pain killer that isn't as strong as Tylenol w/ Codeine but works better than just plain ole Tylenol. Like I said above, I am on the soft/very mush diet and am eating pretty much anything that is soft and mushy! I have yet to vomit and am holding everything down. I am getting nauseous here and there when I eat a bit too much, but once I hiccup like 4 or 5 times, it passes. How're you doing? Feel free to send me a private message and we can continue to talk

Sorry to hijack your post @@Anxious2beme!! Keep us posted on your P2P!

[Anxious2beme 93]

@@Ashlegal @ thank you so much for the support. I just left the MDs office to tell me that the P2P was with an older woman who is sticking with the denial. Even though I have very high BP, pre diabetic and meet all qualifications, they need more proof that I attempted weight loss. They told my MD she feels I can lose it on my own. She then told them to resubmit it. My MD said sometimes you get the older women who are just against GB and set in their ways. They are going to resubmit and send in my Jenny Craig info from last August thru October. Shows a high BMI. But what else can I do? They told me not to give up but I am so so upset right now. ????

[Anxious2beme 93]

I tried to call the insurance to file a grievance but said they don't have that. She said I can file an appeal but my ms is resubmitting it as requested. I told her I want to send in my opinion regarding the denial and was told to fax it along with records, which I don't have, but my MDs office does. I just feel like I've lost and never felt so disappointed in my life. I don't get a second chance to start my new life. ????

[newmebithebypass 713]

I'm so sorry that this is happening