So Sad

[QueenOfTheTamazons 634]

Thank you, would it be beneficial to do it now and then when everything is submitted to insurance have them send that as well? Or should I wait if it is denied?

My insurance is requiring that I have 2 year history with my BMI being over 40 and I just went back to an appointment from last year in may and it was only 38. I was extreme dieting at that time, I have been for the longest basically starving myself. and I did not go to a doctor unless I had too. So I am officially counting myself out. What else could possibly help me? smh. Sorry for the pitty party.

Write up a letter describing your attempts at weight loss, how the weight effects you physically and emotionally, family history of co-morbidities etc. It helped me get my approval pushed through... it cant hurt.

I would write it now and check with dr to see if they would send it with the official package. Why waste the time? It might take weeks for them to re-review your case. The appeal process is different for each company.

Go through the entire list of bariatric comorbidities. There are more than the commonly used ones. You might have a couple of the "second tier" issues.

I also talked about my family history, specifically things that are weight related. I described medical issues that were not comorbidities but that were effected by weight, such as the tendonitis in my elbows ive had for 2 years or how the combination of my osteoarthritis and edema in my feet make it almost impossible to exercise enough.

Equal parts sob story and medical facts.

[kimini 175]

The surgery was an exception for my insurance, meaning they wouldn't cover it at all. My surgeon checked me for a hiatal hernia (which I had, and he says most obese people do), and the insurance paid for that surgery, including hospital visit and anesthesia. It ended up being about half as much, and I was able to get right in with almost no waiting. I don't know if this is an option financially for you, but it seems to me that saving the money to self-pay is never discussed here, but is always an option, and may take less time. Just a thought.

Insurance companies are getting hip to this tactic and a lot of them are going out of their way to make sure it doesn't happen, some even view it as fraud. More than a few people have posted about it lately.

And people self pay all the time on here. In Mexico and the US. A few of the most vocal long time members that post here were all self pay, I can name 3 off the top of my head that are vets and self paid. There are more long term successful people that self pay than people that had insurance, and that just speaks to motivation.

@@hudjess

Honestly for what you spend out of pocket on co-pays and co-insurance, you can just self pay in Mexico for about the same amount, and when you add in that you don't have to waste a lot of time, on visits, you really come out ahead.

Fraud?? Really? I had known for a long time that I had issues with my esophagus and had even considered getting scoped/operated on before I ever considered WLS. I think it is a mistake to discount that. I feel like insurance companies will do anything to prevent paying for care. It's ridiculous!!!

[Nancy A1 0]

My lung doctor said I am at high risk for surgery! I use oxygen. I too am sad because I don't know what to do! He said I could have a stroke or die from anesthesia!

[Butterflywarrior 241]

Dobt give up so fast, being pre diabetic is one step to diabetes. Do an appeal!!

[theantichick 2,204]

Appeal.

And appeal again.

Seriously, make them send you in writing the criteria they are using to refuse. Get documentation together from all of your doctors saying this will improve your health.

I needed a knee surgery to fix the cartilage, and there were 2 options. The one I needed has an 18 month rehabilitation, but has been shown to last 15+ years (most patients in Sweden or wherever it was pioneered still had good results 20+ years out). Insurance considered it experimental and investigational despite the reams of peer reviewed research and articles showing it wasn't. The option they would pay for had an 18 month rehabilitation, but was guaranteed to fail within 10 years, most people didn't even see 7 years of success before it failed.

It took me 5 appeals (insurance company lied to me about the appeals process) over 10 months and over 3 reams of paper overnighted to them. My final appeal outlined the federal regulations they had violated in the appeals process and demanded that an orthopedic specialist review the file. In the end, they paid for my surgery. 8 years later, the knee is still doing well.