DENIED---PLEASE HELP!

[jonfsgirl 1]

I just received very bad news..... United Health Care TNCare has denied me to have the gastric sleeve due to my BMI being under 40 and my blood pressure is controlled with meds. Of course my BP is controlled with meds...what do they want me to do? stop taking my meds and have a heart attack???? This is awful. My surgeon now wants me to send a copy of my sleep study report that was done in 2014 and they will submit that with my paperwork and try again. I never knew it even mattered if your comorbidities were controlled by meds or not. Any suggestions or info is greatly appreciated at this point. I am sooooo upset. I have done everything that has been asked of me ...jumping through hoop after hoop and now this. I am 5'2" and currently weigh 203 lbs with a BMI of 37.1 if have high blood pressure, sleep apena, GERD.

[Valentina 2,642]

I know this is all new to you and is extremely upsetting, and I am sorry you are having to go through this right now.

However, I bet this is not your bariatric surgeon's first denial for one of his patients. His office will have a "plan B" ready to go for you. --like the one they suggested and is working on--the sleep study.

Talk to the office Medical Secretary/co-ordinator. She/he will be the person "in the know" about this.

It probably won't, but if "plan B" should fail, then a "Doctor to Doctor" direct phone call will get the approval.

You have had another hoop to jump through, and I'm sorry about that. Just remember that the people who approve or deny procedures sometimes are not doctors or sometimes they are not even medical people. Sometimes their expertise is in finance. Sad but true.

Try (I know that's a huge task right now) not to worry. Let this play out.

Prayers going up for you!

[#MagicWithinme 173]

How low was your BMI? When I went in a few years ago 2011, the BMI was 35. I was told that was going to be lowered (I guess so more people would be able to get the lapband).

haven't heard anything since.

Or it could be your insurance specifically?

[claddagh66 132]

I'm at a 38bmi and am 5'. I have not been submitted yet but my doctor had completely reassured me as long as I didn't go below 35 I'd be just fine.

I'm sorry your going through this. This whole even is emotional enough. I wish you luck the second time around and hope they find a way to pass you this time.

I too am on maintenance meds for thyroid, herniated discs and gerd.

[Susan Michelle Autry 10]

I know this is all new to you and is extremely upsetting, and I am sorry you are having to go through this right now.

However, I bet this is not your bariatric surgeon's first denial for one of his patients. His office will have a "plan B" ready to go for you. --like the one they suggested and is working on--the sleep study.

Talk to the office Medical Secretary/co-ordinator. She/he will be the person "in the know" about this.

It probably won't, but if "plan B" should fail, then a "Doctor to Doctor" direct phone call will get the approval.

You have had another hoop to jump through, and I'm sorry about that. Just remember that the people who approve or deny procedures sometimes are not doctors or sometimes they are not even medical people. Sometimes their expertise is in finance. Sad but true.

Try (I know that's a huge task right now) not to worry. Let this play out.

Prayers going up for you!

Thanks so much

[Susan Michelle Autry 10]

How low was your BMI? When I went in a few years ago 2011, the BMI was 35. I was told that was going to be lowered (I guess so more people would be able to get the lapband).

My BMI is 37.1

haven't heard anything since.

Or it could be your insurance specifically?

Hopefully plan B will work

[Yaberhoo 358]

I hope plan B works for you. If not, Mexico is a wonderful alternative. My insurance wouldn't consider covering my surgery at all and my bmi was 57. So I did some solid research, found a respected company in Mexico and paid out of pocket.

[Susan Michelle Autry 10]

Thanks Yaberhoo hopefully I will hear something next week