dede0314 356 Posted September 17, 2015 Sorry you're going through this. Don't give up appeal until you can't anymore. My insurance denied me three times and I finally got approved through an external review. It's frustrating because it takes time but it's worth fighting for. Share this post Link to post Share on other sites
Anxious2beme 93 Posted September 18, 2015 @@dede0314 this is very reassuring and I very much appreciate your suggestion and positivity. I am not a quitter, and will do what it takes to get this approved. I am not ready to give up and will take the advice of all of you here. Thank you so much for the support. Share this post Link to post Share on other sites
Anxious2beme 93 Posted September 18, 2015 Oh, 1 more thing. I contacted the insurance to see if I could file a grievance, but they said they don't have that. Would you suggest I write a letter to them with my "opinion" to the Medical Review Board? Thank you. Share this post Link to post Share on other sites
Helen Marie 0 Posted September 18, 2015 So sorry hope everything go better. What insurance company do you have. Maybe will help some of us too. Share this post Link to post Share on other sites
Anxious2beme 93 Posted September 18, 2015 BCBS Illinois Share this post Link to post Share on other sites
Dar200 285 Posted September 19, 2015 In the handouts I got at my first meeting with my surgeon they have an outline that shows the flow of what is going to happen in what order. A chart. Part of it shows the square for sending in for approval. It has two boxes below, one says accepted and points to next steps. The other box says denied and says how they routinely resubmit and get approvals. Doesn't say how many times, just that they expect it and are set up for dealing with. My gut feeling about you writing a letter. They are trained to only pay attention to medical information. I understand your point and I can't imagine how frustrating this is for you right now, but maybe write the letter to get your feelings stated, but hold off on sending it to anyone. If it's some grumpy old women, she may even take offense to it. I can't believe I just said that! I'm an old woman, but not grumpy. Share this post Link to post Share on other sites
Anxious2beme 93 Posted September 19, 2015 @Dar200....wow, what a great handout. We were prepared with an ammunition of information minus the denial information. I too am holding off and taking this piece of advice. For me to send an appeal would be a different story, but this "grumpy old woman" did suggest to the MD to resubmit. I've done all that is required of me, I now sit and wait, again. This last visit, my blood pressure was 130/93, while on blood pressure medication. The heart rate of 119 obviously expressed me being upset, but will still be submitted. I thank everyone for their sincere thoughts and wishes and advice, most of all. I will keep you posted and ask for a prayer that this does go in my favor. Thank you all ❤️ Share this post Link to post Share on other sites
armywife79 123 Posted September 23, 2015 Hi, I'm SO sorry to hear about what is going on with you. This discrimination in the medical ?insurance community should be illegal by now but it isn't yet. I had the very same thing happen to me after my bad removal. They took out my defective band and then denied me twice! PLEASE contact Lindstrom Obesity Advocates in CA. The owner is a WLS patient himself and an active obesity lobbyist actively in congress trying to overturn laws that allow these insurance denials! He also goes all over the country to TEACH doctors and staff how to handle these bullies! The fought TRI CARE HUMANA and WON! for me! on a last appeal! I am now only 25lbs away from weight and really owe it all to them. They will work on what ever budget you have to go on and its not really that much to get it all done. Kelly is who you'll deal with and she will put at ease. Please call them they will help make sure you have the best shot possible! Share this post Link to post Share on other sites
Anxious2beme 93 Posted September 25, 2015 Thank you so much for this piece of advice...I will be sure to hang on to it @armywife79. Today, my insurance coordinator told me that she resubmitted it to my insurance yesterday and marked it urgent. She said it shouldn't take nearly as long as it did last time to hear back. I'm hoping to hear better news this time, she submitted with weight loss attempts documented from Jenny Craig and Weight Watchers from 2012 and 2014 along with the 26 pages she has of documentation. I have since denial been out on steroids from a horrible rash i got but have no idea other than chronic hives. Needless to say, I'm gaining a little more weight. Please say a prayer that the 2nd time around will bring a big fat approved. Thanks for the advice and for listening to my story. ???????? Share this post Link to post Share on other sites
armywife79 123 Posted September 25, 2015 I have my everything crossed for you! Share this post Link to post Share on other sites
Anxious2beme 93 Posted September 25, 2015 APPROVED APPROVED APPROVED!!!! I got the call this afternoon that insurance approved me for the GB RNY 3 days after resubmission!!! I am just bouncing with excitement and gratitude!! I am so thankful for being given this second chance!! I cannot believe it's happening to me ????????????????????????????????????????????????????????????❤️???? thank you thank you so much for listening to me and sharing your stories and helping me relax and try to breathe-that it wasn't over yet. It's not - I just have been given a chance to live again. So thankful ???????????? Share this post Link to post Share on other sites
Daisee68 2,493 Posted September 26, 2015 Congrats! Great news!!! Share this post Link to post Share on other sites
armywife79 123 Posted September 26, 2015 Omg!BEST DAY EVEER! Share this post Link to post Share on other sites
GBLady41 393 Posted September 26, 2015 ???????????????? Share this post Link to post Share on other sites
