sassyfrass23 525 Posted January 4, 2016 (edited) Hello, everyone! I hope 2016 has been treating you well thus far! I am here tonight to request your experiences/advice with my current situation. A quick overview of where I'm at in the process: tomorrow I have an ultrasound of my gallbladder and liver. The 13th I have my EGD and a follow up appointment with my surgeon on the 20th. I completed my 6 month attempted weight loss in December, so my file should be ready to submit by the end of this month or early in February. With that being said...here's my problem: Since June, I have treated this surgery as if I have already been given the thumbs up by insurance. I have spent countless hours researching every aspect of this surgery. This site has been a God send. I simply want to be as prepared as possible. But as I approach the end of this [ridiculously] long process, I've become more aware of the possibility of denial. I meet all requirements, but I am also fully aware of insurance and how difficult they can be (yes this surgery is in my plan). And now my nerves are through the roof. I've spent 7 months preparing for something that may never take place. I know that I shouldn't get myself worked up over something that hasn't happened. But my biggest concern is how I will react *IF* insurance denies me. I know I can appeal and resubmit. But I've read plenty of stories of patients who did that and we're still denied. So, I basically feel as if I've prepared for the best case scenerio without any consideration for the worst. I'm hoping that any of you can offer some advice to help me relax as this chapter comes to a close. Did you experience this same anxiety? How did you handle it? Were you denied on your first attempt? How was the appeal process for you? I have faith that what is meant to be, will be. But I can't bare to think about the disappointment I will endure, should this not go through. Thank you in advance! Edited January 4, 2016 by sassyfrass23 Share this post Link to post Share on other sites
Pinkgirl1234 761 Posted January 4, 2016 Don't let your head drive you crazy....just keep going and finish the hoop games.....time is moving fast. Share this post Link to post Share on other sites
Pinkgirl1234 761 Posted January 4, 2016 Just don't get BMI below 40 .....before submission to insuranc. e Share this post Link to post Share on other sites
James Marusek 5,244 Posted January 4, 2016 Put blinders on. I ran into a lot of problems along the way with my insurance. They did very unusual things. I went through a 6 month medically monitored weight loss program. They paid for my doctor visit for the first month but not the second month. When I asked them why they didn't pay, they said weight loss is not covered by my plan. They paid for the 3rd month visit but not the 4th. I contacted my insurance and they said they made a mistake but not to worry, they would not ask me to repay them. They paid for the 5th visit but not the 6th. I just put blinders on and charged ahead. I figured this was just some game the insurance companies played to make sure I was really committed to this process. If you encounter roadblocks, just keep trying to go forward, until they give in. Share this post Link to post Share on other sites
sassyfrass23 525 Posted January 4, 2016 Thanks, guys! I am my biggest enemy at times. Whether it's me critiquing myself or....almost telling myself that good things won't happen. This will probably be a bigger mental challenge for me than anything else. Which I'm almost grateful for. I have a few things I need to work out and I believe this surgery will make me face those issues head on. I've got my blinders on and will continue to push forward. I do deserve to be happy..and it's ok for me to take care of myself. James- that's crazy how your insurance company flip flopped on each visit. But I believe you're right- I think this is part of the game insurance plays. And those who fight until the end will reap the rewards. Got my boxing gloves on now Share this post Link to post Share on other sites
cassie32104 70 Posted January 6, 2016 I felt the same way. I wish I could tell you to stop worrying about it, but I know that there was no way I could! I met all the qualifications, but still worried myself to death about being approved. I was approved the first time....within 48 hrs of submission! I was prepared to argue with the insurance company if I needed to, because I absolutely knew I met all the requirements. I was also prepared to finance surgery if I were denied, not having surgery was just not an option in my head! Share this post Link to post Share on other sites
