Denied and Grieving

[Jemma23 29]

I can’t express the frustration and emotions I have gone through this past week. I literally feel like I am grieving. I got to the end of the Whole process. I used sick days from work to go to my countless appts. I paid for all these pre-op visits including heart stress test and echo that surgeon required for pre-approval. I have spent countless hours reading posts, watching videos, following journeys, making notes and lists. I paid for my surgery in full and surgery scheduled for July 18th. I was so pumped and happy that I finally had some hope of being able to walk without pain, get rid of this miserable sleep apnea machine, get on the right path to lower cholesterol and blood pressure and hopefully not end up immobile like my mom who had her first heart attack at my age. Then I got the call... you have been denied! How? How can this happen? Why put me through all this time and money, get my hopes up, to deny me? I am so beyond mad. Considering I hadn’t told anyone but my husband, I have no one to vent to... so I’m venting to the only ones who can possibly understand my tears.

[MysticHippie 4]

I feel for you. So sorry you're going through this. Did they say why you didn't get approved?

[Frustr8 7,886]

Yeah I would like to know myself! Do you have time or resources to devote to getting this capricious decision overturned?

[Midnightsun 129]

I am so sorry you have been denied. It has to be a horrible feeling especially after working so har for this and looking forward to the surgery. I would say this is not the end and take a step back and look at why you were denied. Maybe something was missed on the paperwork submitted. You should have been sent something of why you were denied. If not call your insurance and see if there is something else needed. Your surgeons office should be able to help you as well. They make money by doing the surgery so they may be able to give you some advice on getting approved. Don’t give up, just regroup and find out what needs done. Don’t give up.

[Jemma23 29]

When I first applied for process, I went through my pcp. Apparently they measured me wrong and put me at 5-2 instead of 5-3. My measurements put me right at a 35 BMI, which is lowest bmi they will accept into program, but... I have many medical issues. So, when I got to my first surgical visit they measured me at 5-3 so I was at a 34.2 BMI so I gained a few lbs and came back. Then we continued with entire process, MANY appts, which you all know process. After I paid and scheduled surgery date, ins called me 3 days later and said “she had GOOD news, I was just too skinny to have the surgery”. I begged, cried and pleaded with her. As soon as I got off phone with her I drove straight to surgeons office and cried to them. They called insurance and plead my case. Then I called insurance back next day. I don’t know how else to fight it. Its a done deal. All over an inch discrepancy or 3 lbs... doesn’t matter that I have cholesterol of 300, prediabetic, fatty liver disease, sleep apnea, high bp, plantar fasciitis, auto immune and my mom had her first heart attack at 50.

[SusieQ2019 567]

I am sorry to hear that you were denied after completing all the requirements. How could they denied you after you paid the surgeon in full. Your BMI is low but you mentioned that you have sleep apnea and high blood pressure which is 2 qualifying commodities. I hope you are able to proceed with the surgery.

[Pjj431 71]

Horrible. If you paid surgeon who denied? Insurance? Did they say why? Sounds like surgeon should be able to help you. Sounds like you have a case to me. Do not give up. Fight for this life saving surgery.

[Jemma23 29]

Insurance told me that they have so much money allotted for this surgery, so they can’t allow it for everyone. I heard way too many wanted in the program this year so they were looking for mistakes I’m sure.

[GreenTealael 25,330]

Go through the appeals process and see how it turns out. But what did you actually pay for? Can you get a refund?

[GradyCat 3,695]

I know it feels like a letdown, but look at the upside. You're only 200 pounds and your BMI isn't that bad. It might be something your doctor and the insurance company feels you can work on without surgery. You sound like you have a lot of get-up-and-go and are determined, so I bet you can do this. You've got this! Hang in there.

[Midnightsun 129]

I just looked at your profile. We are so similar. 5'3 but you let your weight fall to 197 that puts you at 34.9 bmi. It is a 40 bmi no comorbilities. Or a 35bmi with comorbilities. I had to keep above the 35bmi to qualify for surgery. I let my lowest go to 200 to be in range. Your Dr. And Surgeon should have let you know this. I would get the qualifications from insurance if you have the comorbilities just put on a little weight.

[Frustr8 7,886]

Yeah gain a little weight, don't remove your shoes, put rocks or fishing sinners in your pockets, be. a devious if necessary. You have enough co morbid and potential co morbid that I feel this quibbling is asine. 34.9 isn't that far from 35 , wait to have your💩 Poo until after your next weighing. The grieving is not good for you, you may have a heredity tilt towards joining your Mama early, now that we have met you, we sure don't want to lose you.
I have a bent towards depression myself, put up a yellow caution flag until they realized not having my surgery had put me in a BLUE FUNK, my surgery instead of making me worse helped me get better! And , knock on wood, I am truly better now. Just like any other addictive I will always have depressive tendencies but they are pushed to the rear and don't affect my daily life anymore.

[Jemma23 29]

There is no next appt. I am out of the program... no more appts.

[Midnightsun 129]

1 hour ago, GradyCat said:

I know it feels like a letdown, but look at the upside. You're only 200 pounds and your BMI isn't that bad. It might be something your doctor and the insurance company feels you can work on without surgery. You sound like you have a lot of get-up-and-go and are determined, so I bet you can do this. You've got this! Hang in there.

I am sorry but this post really upsets me. You see all the health issues this woman has and fears of a heart attach how can you minimize her struggle? We are suppose to be supportive and come to this group for support and guidance. I am in the 35 BMI and struggled my whole life with ups and downs. I lost 30lbs thru Keto and put it back and the dr said that was worse than the weight so I made the decision not for hopes of a bikini but for health reasons. She needs this surgery for the same reasons, so she can lose and keep off the weight. If it was so easy no one would need surgery.

[Midnightsun 129]

1 hour ago, Jemma23 said:

When I first applied for process, I went through my pcp. Apparently they measured me wrong and put me at 5-2 instead of 5-3. My measurements put me right at a 35 BMI, which is lowest bmi they will accept into program, but... I have many medical issues. So, when I got to my first surgical visit they measured me at 5-3 so I was at a 34.2 BMI so I gained a few lbs and came back. Then we continued with entire process, MANY appts, which you all know process. After I paid and scheduled surgery date, ins called me 3 days later and said “she had GOOD news, I was just too skinny to have the surgery”. I begged, cried and pleaded with her. As soon as I got off phone with her I drove straight to surgeons office and cried to them. They called insurance and plead my case. Then I called insurance back next day. I don’t know how else to fight it. Its a done deal. All over an inch discrepancy or 3 lbs... doesn’t matter that I have cholesterol of 300, prediabetic, fatty liver disease, sleep apnea, high bp, plantar fasciitis, auto immune and my mom had her first heart attack at 50.

Did you have shoes on? It isn’t over. You just need to meet the weight requirements. You can do it and qualify. Unless you wanted to fight the inch maybe you had shoes on etc. Call your primary and the surgeon and find out what you need to do. It may be a few more steps but you can make it happen. If you have medical records online you can look at previous heights etc and see if they have others in a as 5.2 but I think the easiest would be put on weight and start again. Don’t give up.