Denied :(

[Beth's WLS Journey 29]

I went to the bariatric doctor in May to get everything started on my WLS.

At that time, the office called my insurance company (BC/BS) and was told everything that we required. Asked specifically about a 6 month regimented diet and was told that it wasn't necessary. Because my BMI is 50, I should qualify for WLS.

Over the last 2 months, I've gotten all my pre-op work done and the doctor submitted all the paperwork for pre-authorization. They were then told that I am being denied as there is no documented proof of a 6 consecutive month exercise/diet regiment with a nutritionist. Of course, my doctor's office got involved and negotiated twice on my behalf with the case nurse but she said that is their criteria.

And I have been officially denied until they see that I have followed a 6 month program. If they read my diet history that I sent them they will see that I have been on diets my entire life - you name it, I've done. Sure the weight comes off, but then comes back on plus more. I even went to a nutritionist for a year but that was several years ago, and they only want to see the past two years. Can you feel my frustration?

I met with a nutritionist today and are starting to play this game. Since I met with one in June for the pre-op, I just barely got by in July so at least I have 2 under my belt.

I just know that come end of November, the insurance company will try to find something else to deny me. Say I didn't lose enough (even though they are not saying what that "enough" is). I want to get this done this year as I've already hit my deductible. I'm sure that case managers are supposed to do whatever they can to deny a procedure because of the cost involved. Do that not see that there is more health costs involved with morbid obesity?

I am so angry; I can scream!!!!

[AnA92212 577]

I'm so sorry. I can't even imagine the frustration. Hoping that playing the game will pay off.

[The Candidate 3,215]

I totally understand your frustration. I had to wait an entire year meeting my insurance's criteria. It was so hard and there were many times I was positive that time was going backwards. But eventually my day finally came and now I'm a year out and at goal.

It's worth everything they put you through and I promise you once you're a post op this time will seem like nothing!

Best of luck!

[Beth's WLS Journey 29]

^{Thank you. I needed to hear that about now......I am certainly not giving up. I am more eager now to have this done than ever. When someone tells me "no", I tend to see it as a challenge to get what I need in the end!!! I've been overweight all this time, so what's a few more months? Its just frustrating knowing that the insurance companies are "in charge" of your health...}

<sup>I totally understand your frustration. I had to wait an entire year meeting my insurance's criteria. It was so hard and there were many times I was positive that time was going backwards. But eventually my day finally came and now I'm a year out and at goal.

It's worth everything they put you through and I promise you once you're a post op this time will seem like nothing!

Best of luck!</sup>

[Daenerys Targaryen 109]

I jumped through all the insurance hoops and they still tried to deny me twice. Then I hired Lindstrom Obesity Advocacy Group, and between pressure from Lindstrom and my surgeon doing a peer-to-peer, my denials were overturned and I had my surgery this past Wednesday. Don't take no for an answer if it happens. Many insurances make you battle for approval.

[KristenLe 5,979]

Do they have proof of that initial call - I'd fight that! Can they show you where the requirements are documented - because my bcbs couldn't! I had to wait until surgeon submitted to hope I met requirements(which I was told I had a 6 month supervised diet requirement at first when I actually didn't)! I'd be furious and BCBS would hear about it!

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[KelseyBennett_vsg 28]

I hate to hear that this is happening to you as well! My insurance did the exact same thing to me even though my BMI is above 60 :/ I just finished the 6 month weight loss study, didn't lose any, maybe 3 lbs overall, but still up 8lbs from my initial surgeon consultation.... So I'm kind of in limbo. Mine should get submitted from pcp to surgeon then to insurance sometime next week. I sincerely hope that you don't have any more roadblocks in your journey!

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[Amurillo04 109]

From my experience insurance reps over the phone are extremely untrained in what's needed for each individual plan and that is very frustrating. I'm surprised that your surgical coordinator didn't find out exactly what you needed in the first place. Regardless of that the time will go faster than you think and with a bmi of 50 I doubt you'll be denied once you qualify. Good luck

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