Peer to peer

[Brenda Sherwood 64]

My isurance (a form of medicaid) denied me as they are saying they require comorbidity even with high BMI. My Dr is fighting for me and has a peer to peer scheduled. Wondering how many people have had a successful outcome from peer to peer? Did it or didnt it work for you? Considering hiring a bariatric attorney

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[britknee 8]

Praying it will work out in your favor. I too have Medicaid in Illinois and will be meeting with my surgeon soon and then having my insurance submitted for prior authorization. I think it will

Work out in your favor though.

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[melyssafaye 181]

I have Medicaid in Illinois as well. I went to UIC, which was in network for my managed care plan. I followed the requirements, did the 6 month supervised diet and had surgery on 3/31. There was no problem with approval so long as my BMI was over 40. The biggest thing I learned was that I had to follow every doctors instructions 100% and follow through, even when I may not have wanted to, because they will object if you are "non-compliant". Good luck and I hope you get approved after a peer-to-peer.

[Brenda Sherwood 64]

I was on a 6 month diet, insurance changed requirement to 3 mo right at my 3rd appointment so they had me jump though all the other hoops super fast (ekgs, psych, blood, stress, preggo, etc) and I was 5 days into my liquid diet when I found out they said no. Super bummed. Did everything they said to a T and lost 28lbs in the process. Insurance came back saying I needed proof that I had conditions making me disabled due to my obeisity even though BMI of 46

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[britknee 8]

Wow that's crazy. I hope after peer to peer you get approved. I think that just might be your insurance company's way of deterring you but don't give up. Keep us posted. I know how anxious u must feel but I truly believe this will work out in your favor. The doctors know exactly what to say to get you approved and it's great that they're going the Extra mile. Hang in there and keep us posted!

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Edited May 15, 2016 by britknee

[britknee 8]

@@melyssafaye did you have any comorbities?

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Edited May 16, 2016 by britknee

[melyssafaye 181]

I had high blood pressure, but it wasn't being treated with meds. I did the sleep study and snore but no apnea.

My managed care company didn't require comorbidites with BMI of 40 or over.

[britknee 8]

Awesome sauce!! I don't think mine does either. My BMI is 42

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Any word yet @@Brenda Sherwood

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Edited May 20, 2016 by britknee

[Brenda Sherwood 64]

No word. Peer to peer in a couple weeks. Im in no hurry now because I cant get surgery til end of July because my job is crazy busy late May til mid July

[gina171 626]

Brenda, I have my fingers and toes crossed for your appeal!

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[WantToBe 77]

Brenda - my insurance company denied my lap band removal! My surgeon did a peer to peer and approved the removal. I hate to say this - is there anything you could document as a comorbidity? Maybe go deep into your records and find something? I wish you good luck with insurance company.

Edited May 22, 2016 by WantToBe

[Brenda Sherwood 64]

Brenda - my insurance company denied my lap band removal! My surgeon did a peer to peer and approved the removal. I hate to say this - is there anything you could document as a comorbidity? Maybe go deep into your records and find something? I wish you good luck with insurance company.

They have family history listed and my mother had every problem possible and died at 62 so we are going to try and use that. I told them i have bad knees that most likely will need replacing in the next few years, my aunt died in her 40s and was close to 600lbs, a couple other things. We will see...

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