Trying to stay positive.....

reese711 · March 8, 2017

So I got my second denial last week because 1. They need proof my obesity is not endocrine related, easy enough. I just had normal thyroid levels drawn last month. My swallow test showed mild gerd and they want that treated. Also easy, my pcp called in a script. My first denial was because I hadn't participated in the 6 month weight loss program and had not done upper gi testing. My insurance coordinator calls me today and says I need to re do the 6 month program because in the 3rd month I gained 2 lbs. overall I lost 14 lbs from initial weigh in to my 6th appointment. Anyone else have this happen to them?!?!

julasif · March 9, 2017

That is absolutely awful! My dr. office told me it shouldn't matter as long as you didn't gain weight overall. I was worried because in my 1st month I actually gained a pound too. What insurance do you have? I know there is a legal group that will fight insurance companies on bariatric denials. Maybe someone can chime in with more about that. I'm so sorry your insurance is so dishonest.

reese711 · March 9, 2017

I have blue cross blue shield. I'm just going to do two more months so that it shows 0 weight gain the entire 6 months. I don't want them to have any reason to deny me again. At this point I've been jumping through hoops for 7-8 months there is no way I'm stopping now. Over 2000$ in and down 22 lbs as of this morning. Not happening. I'm determined to get this approval!!!!

julasif · March 10, 2017

Oh No! I have BCBS too. Through Bank of America. I'm on my last month that but I gained 2 lb in month 2 also. At my last weigh in next week, I should be at a total loss of 4 pounds. This is because my bmi was only 37.2 so I was afraid to loose too much. It's like you're damned if you do and damned if you don't. What state are you in? I'm in the Dallas area.

Walter.Sobchak · March 10, 2017

That is interesting.
I haven't been told that we cannot gain weight at all during the six month period.
Isn't the point of the surgery to help us lose weight?
If we could do it on our own, we wouldn't need surgery.
Insurance companies are so crooked.
I lost weight at my first check in, but I am afraid I have gained this month.
I will have to ask at my appointment next week.
That would be very disappointing if they will keep making you do the six month wait each time you gain.

reese711 · March 10, 2017

Oh No! I have BCBS too. Through Bank of America. I'm on my last month that but I gained 2 lb in month 2 also. At my last weigh in next week, I should be at a total loss of 4 pounds. This is because my bmi was only 37.2 so I was afraid to loose too much. It's like you're damned if you do and damned if you don't. What state are you in? I'm in the Dallas area.

I'm in Nebraska. I kind of wonder if the insurance coordinator doesn't really know what she's talking about. It's all very frustrating. I just keep fighting them.

Walter.Sobchak · March 10, 2017

I am wondering if you could call your insurance directly and ask them the requirements?
Maybe they can provide you with a better understanding?

aquarious12585 · March 10, 2017

I have blue cross blue shield. I'm just going to do two more months so that it shows 0 weight gain the entire 6 months. I don't want them to have any reason to deny me again. At this point I've been jumping through hoops for 7-8 months there is no way I'm stopping now. Over 2000$ in and down 22 lbs as of this morning. Not happening. I'm determined to get this approval!!!!

I also have blue Cross and on my 2nd denial. I'm so frustrated:(. Best of luck to you

reese711 · March 11, 2017

I also have blue Cross and on my 2nd denial. I'm so frustrated:(. Best of luck to you

What are the reasons for your denial?

aquarious12585 · March 11, 2017

3 hours ago, reese711 said:

What are the reasons for your denial?

Denied for not meeting all of the insurance requirements. I haven't had a consecutive 6-12 months of medically managed weight loss :(. The insurance only sees black and white. Next step is the peer to peer