Denied

[Jazzzyjay 222]

My surgeons office just called me. I was denied. She said she has never experienced this before with my insurance plan. They gave two baloney reasons

First that my blood pressure needs to be higher even though I'm on medication??? WTH does that even mean?? They want to see a constant of 140 over (I don't remember the number) while trying to be controlled

Second. I have not lost enough weight. I'm down to 199 if I get any lower I will now qualify.

I started loosing weight on my own at 245 lbs. I originally went to the bariatric center to get help with medication weight loss. That was when I found out I had high blood pressure and the dr said definitely no she would not give me medication to aid in my weight loss. They took that weight 215 and compared it with the next weight they had 9 months later ( once I decided to go for surgery) I had gained 9 pounds...over the period of 9 months.

Sorry if I'm all over the place with this I'm just so upset. My dr has had to up my high blood pressure medication once because it was not working. I have a appointment with her this afternoon to see if she can fax that to my surgeon. The bariatric center has 14 days to fight it. If they don't win it's a definite denial. My surgeon is going to do an eye to eye?? With the insurance.

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[laurak814 43]

I'm so sorry. How long have you been on blood pressure meds? What do you your pressures normally run on medicine & what were they when you were diagnosed? It sounds to me that your insurance is just looking for excuses not to pay. Hopefully your Dr can work some magic & talk the insurance into changing their minds.

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[Jazzzyjay 222]

Thanks. I've been on blood pressure meds for roughly 8 months. Honestly I never paid attention to my numbers. I guess that's part of my problem. I didn't even know I had a problem until I tried to get medication to aid in weight loss.

The surgeons nurse said she doesn't know why they are doing this. Throughout my 6 month supervised diet I asked my dietician if there was anything that could cause me a denial. She said no.

I'm seeing my PCP this afternoon. I'm going to ask her to fax over the proof showing she has had to up my dosage. I'm hoping that gives my surgeon ammunition.

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[Djmohr 6,965]

@@Jazzzyjay

Many times in that peer to peer discussion, denials are overturned. Lets hope in your case that is what happens. I will say a prayer for you.

Best of luck!

[Jazzzyjay 222]

@@Jazzzyjay

Many times in that peer to peer discussion, denials are overturned. Lets hope in your case that is what happens. I will say a prayer for you.

Best of luck!

Peer to peer lol yes that's what she said not eye to eye....see I'm so upset I can't get anything straight.

Have you heard of that working?

BTW I just had to tell you. I see your replies and comments. I really value and respect your honestly, straight forward ness and kindness. I aspire to be as strong as I've seen you have been. Thank you for your prayers!

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[laurak814 43]

@@jazzyjay I'm very conscious of my BP b/c I've had issues for many years & high BP & heart disease runs in both sides of my family. You are new to the high BP family so you aren't as aware of the numbers, lots of people aren't. I bet your Dr will be able to get the insurance to revise the decision after the talk. Try not to stress about it. ❤️

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[Jazzzyjay 222]

Thank you. I just got off the phone with the surgeons nurse again. She said my weight is not a factor it's the blood pressure they want to see 140/90 not being controlled with my current dosage. But my blood pressure is being controlled at this point. So does it have to get so out of control that I have a heart attack?

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[Cocoon2Butterfly 64]

@@Jazzzyjay I was denied twice. I complained to my human resources and they put me in contact with the insurance approval dept. After almost 45 days after the forms were filed, I was approved. Talk to the Insurance.

Cocoon to Butterfly

[Jazzzyjay 222]

@@Jazzzyjay I was denied twice. I complained to my human resources and they put me in contact with the insurance approval dept. After almost 45 days after the forms were filed, I was approved. Talk to the Insurance.

Cocoon to Butterfly

I was reading your story. Way to fight it out!!! I'm in this for the long haul. Definitely not stopping. I've worked so hard for this.

I have Medicaid, not sure if that matters.

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[Jazzzyjay 222]

Blood pressure is 156/96 that's on my meds. I guess I should start keeping track of it.

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[laurak814 43]

@@jazzyjay that doesn't make sense for them to want to see it not being controlled. Unless they want it to be bad enough that it isn't able to be controlled with medication. Which if you hadn't lost a bunch of weight already, your BP would probably be worse but still not out of medicinal control. Medicaid might have tighter guidelines than private insurance, but private insurance policies vary depending on the employer or buyer or even the insurance company. Keep your chin up!

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[laurak814 43]

@JazzyJay- that is on meds?! That is considered high. Anything over 140/90 is high. If you are able, take your pressures daily, or as often as possible. Even if you get your own machine or go to a pharmacy & have those automated machines do it. Keep a record of them to show your surgeon.

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[Jazzzyjay 222]

Yes that's on meds. I didn't even know it. My dr just upped my dosage and gave me a three month supply a couple months ago. I haven't checked it since then. That explains these God awful headaches I keep having.

Well I guess the insurance company is going to get what they want. I hope that's high enough for them

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[Jazzzyjay 222]

@JazzyJay- that is on meds?! That is considered high. Anything over 140/90 is high. If you are able, take your pressures daily, or as often as possible. Even if you get your own machine or go to a pharmacy & have those automated machines do it. Keep a record of them to show your surgeon.

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I have to be more proactive about checking my blood pressure. I'm going to do it every day. There is no excuse that I've let it get this bad and just didn't know. I do have quite a bit of stress in my life. But that's even more reason to take better care of myself!

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[laurak814 43]

@JazzyJay: Don't be so hard on yourself!!! That's going to cause your more stress & a higher BP! lol Before this you thought your Dr was managing it with meds, now you know better. Yes a high BP can cause headaches, so can stress. Too much meds can cause dizziness & fainting, so it's a fine line to walk for a Dr. If your BP has been lower when you go in for your exams, they may have thought they were prescribing correct dosages. But since you have a high amount of stress in your life, that prescription just isn't cutting it. Again, don't be so hard on yourself. This is a learning tool, now you know. I have hbp & I don't check mine daily, but I can tell when it's off & I check it then. I've been dealing with it for 14 years. Cutting the stress from your life is the best thing you can try to do at this point! Both for your BP & your weight/surgery. Cutting Stress is a major factor is helping to overcome major obstacles in life. ❤️

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