Beyond Sad Request Deneied

[DivaSoBlessed 97]

I just came from the mailbox retrieving 4 letters from my insurance provider. After getting all of my clearances completed some how I still got denied. I am sitting here in tears, and frustrated as well as exhausted with this entire process.

The letter says reason(s):

Inadequate or no clinical data received to complete review. I have no more words and am feeling like maybe this is just my life and I should except it. Going to bury my head under a pillow now. #sotiredoffighting

[Jessee3897 114]

Diva no no no. You pick your head up. Call your insurance company and find out just what it is they are missing. Or wait until Monday and call your surgeons office and speak with the insurance person to find out what is needed and have them get on it asap. It is not time to give up. Not yet. This is just a speed bump.

[Proud2BMe 1,016]

You have 2 options:

1. Throw in the towel and just give up.

2. Continue fighting for what you want.

I saved up for almost a year to get my surgery, self-pay in Tijuana. So I don't sympathize one bit with people who chose option number 1 just because they were denied by their insurance.

Edited March 12, 2016 by Proud2BMe

[LaurieMore 20]

Sounds like they just need more info. Don't give up yet!

[Marie2016 87]

Fight for yourself. You are worth it.

[mizzzzzzT 80]

This coming October will be 3 years since I started this process. Since I started they lost my paperwork 3 times and bumped my surgery date because they booked me on Easter monday by accident trust me when I say I know exactly how you feel. Throughout this process I have said I'm quiting more then my fair share and I realized your that much closer from when u started there's nothing going to hold you back if you are persistent. I did more then jump through hoops for these people and it was what seemed like one thing after another. it pays off don't give up!

[DivaSoBlessed 97]

Diva no no no. You pick your head up. Call your insurance company and find out just what it is they are missing. Or wait until Monday and call your surgeons office and speak with the insurance person to find out what is needed and have them get on it asap. It is not time to give up. Not yet. This is just a speed bump.

Thank you! I'm not giving up just yet. I have just come a very long way and I am very emotional right now and confused at the same time. I just opened up the last letter which has me more confused because it says: Bases on the documentation submitted, code number ##### for laproscopy, sleeve gastrectomy (services must be rendered at a Blue Distinction Center) is covered under the member's plan. Howevwr , predetermination of benefits does not guarantee payment.

[DivaSoBlessed 97]

I'm logging on to my computer so that I can respond to you all. Thank you all so much for your input. It helps because I know that I am just thinking irrationally because I am upset.

[DivaSoBlessed 97]

@@mizzzzzzT Yes it looks like we both have had long journey's and I am sure that there are many more of us who have been going through a process of trying to get approved for quite a while. My journey for attempting to get this surgery dates all the way back to 2003. It was even harder back then because no one wanted to get on the phone and explain what is covered and what isn't. I just kept being told that I needed to do a six month supervised diet but that still didn't tell me if I had the benefits to get the surgery beyond that. During that time I had other things going on so I stepped back from the entire process to regroup and just started exercising and trying to eat better and for a long while I was doing well. It would take me a day to explain the journey but fast forward to today. My plate is less fuller and I can focus solely on me so I revisited the idea and discovered no more six month supervised diet so I decided to give it another try last year. The paper work says something about a hiatal hernia not necessary but I don't have that so I am more confused now than ever. I will definitely be giving the surgeon's office a call on Monday. Thank you so much for your kind words. I'm still in this fight. I've come too far not to be.

[DivaSoBlessed 97]

@@Marie2016 Thank you so much! I had to let go of the tears in order to get angry so that I can stand up and fight. I'm not giving up. I'm all in.

[DivaSoBlessed 97]

@@LaurieMore Thank you! I am going to give them a call first thing Monday morning so I can figure this out.

[Valentina 2,642]

So, this is the plan:

Monday, you call the surgeon's office and make an appointment to meet with the insurance rep. (medical secretary--whatever title the office uses)--the employee that is responsible for submitting all completed documentation into the insurance companies.

Then:

You and this person sit down, call your insurance company, find out EXACTLY what they are missing--if anything (you may already be approved), and TOGETHER --before leaving the office--gather all of the needed/completed documentation and fax it--following with the hard copies.

Sometimes we just need to be self assertive. Take your future into your own hands. GET IT DONE!!!!

Keep posting and keep us up to date. (so we can give you another kick in to pants, when needed)

Prayers going up for you, my friend.

[DivaSoBlessed 97]

@@Proud2BMe Thank you for your response. I choose not to give up but please know that this isn't about whether you sympathize with people who do because none of us knows each other's personal journey and what we have gone through. I have empathy and a heart and I understand that not everyone is blessed to have the opportunity to have the coverage that they need to have surgery done. I applaud you for your persistence in making sure that you saved to have the surgery done. Not everyone is able to do this because of limited budgets and it is because of that I empathize with people. Is surgery the only way to lose the weight no but for some people it is literally their only hope and choice between life and death so being understanding of a person's human emotions. No one here can say that went through this process without feeling some sort of emotion especially frustration. We can also sometimes say things that we don't truly mean out of being emotional. Congratulations to you and I wish you well.

[DivaSoBlessed 97]

@@Proud2BMe Thank you for your response. I choose not to give up but please know that this isn't about whether you sympathize with people who do because none of us knows each other's personal journey and what we have gone through. I have empathy and a heart and I understand that not everyone is blessed to have the opportunity to have the coverage that they need to have surgery done. I applaud you for your persistence in making sure that you saved to have the surgery done. Not everyone is able to do this because of limited budgets and it is because of that I empathize with people. Is surgery the only way to lose the weight no but for some people it is literally their only hope and choice between life and death so being understanding of a person's human emotions. No one here can say that went through this process without feeling some sort of emotion especially frustration. We can also sometimes say things that we don't truly mean out of being emotional. Congratulations to you and I wish you well.

[DivaSoBlessed 97]

@@Valentina Thank you so much. That's a great idea! I have an appointment coming up with them so I am not leaving until we all sit down and figure this out. I have come too far for this to go all down hill now. I will keep you all posted on what happens.