Has Anyone Been Denied After Doing Everything The Insurance Asked??

emily111 · June 6, 2008

HI I have BCBS of MN I have done everything they asked. I did the 6 month diet with my last appointment being on the 16th of this month. I have a BMI of 43.. It started at 41 but I gained a few pounds because during this past 6 months my dad died and life has been very very hard. I was told not to loose any weight or I would be denied. Anyways So now its getting close to the day to file and I am sooo stressed. I am worried that I will be denied even though I did all I was supposed to do. So I want to hear from others that may have done all they were supposed to then were denied. Right now I am in the dark because my Doctor I am using is HORRIBLE and the people in his office do not help me at all!! I dont have many options though so I am sticking with them I just want this surgery over with. Anyways someone help calm me down please :wink2: I am thinking to sue the insurance for emotional distress they caused for this 6 month wait lol

eyespy · June 6, 2008

I'm very sorry for your loss. I started my 6 month weight loss plan last May and my father passed away the next month. This June will be one year, and I will be having my surgery in July. I think I probably gained weight, too, although I really didn't pay much attention. It was all I could do to just attend the sessions. I wasn’t in the mindset put for any effort. I just attended the appointment and that's about it, especially the first few months after my dad died.

In fact, I kept going, but had decided not to have the surgery because my dad died unexpectedly from complications of open heart surgery, and I was very scared to go through surgery. He had his surgery at the same hospital where I will be having mine. I knew I might change my mind, so I kept going, and I did change my mind. That's why I'm having my surgery in July instead of June—a little superstitious.

I thought I was going to be denied, not because of the results. In fact, just to give you a little encouragement, I asked my insurance people at the surgeon’s office if you could be denied based on the results, and they said no. What happened to me was that my August session was around the 28th. My next appointment was on October 1, which was a Monday. When the insurance people at the surgeon's office received my paperwork, they told me I would have to do the entire 6 months over because September's appt. was missing. They said that it had to be 30 days and that is was just a game with insurance people to make people give up.

I was devastated. I don't work in the summer, so that is the perfect time for my surgery. I started my 6 month appts. over with a different doctor. My surgeon has a doctor that just does the weight loss programs. I called to find out if I would be able to complete the 6 months and get the paperwork in on time for a Dec. surgery and I spoke to a different insurance person in the office who told me she actually holding my approval letter in her hand!! She decided to send in my paperwork and see. The other person didn't want to because she said if you get a rejection, it's even harder to get it approved the next time.

So, except for the stress of it all, it worked out. I think as long as you meet all of the criteria, everything will be fine. (I have BCBS FL.)

Good luck with everything, and again, I am so sorry about your dad.

Alysa

Nemesis · June 6, 2008

:thumbup: I'm sorry.

I'm thinking if you have feelings this strong about your doctor being horrible, you really - really shouldn't have surgery done with him. If someone is going to be doing surgery on you, you really should have complete trust and confidence in them. If the people in the office aren't helping you now, they probably won't help you after - and you need all the support and help you can get after your band is placed.

Just saying, think this through - perhaps the trouble with your INS is for a reason, helping you slow down a bit and take a look at things.

Good Luck

gone 4 ever · June 6, 2008

Emily, sorry to hear about your father. ine passed away 1 yr ago in April. So I had put mine off also. Is'nt there any other dr. that you can go to? I would look around. Check here on the dr. thread. good luck hon.

emily111 · June 6, 2008

eyespy.. Im sry that this happened to you also. Really its been so hard to keep going and the stress of all these apointments has been very hard. My dad was only 44 and it was sudden. I took and started a double 6 month diet one with the nutritionist at my bariatric center and one with my dr. because I did not want to be denied. I would really like to get a new doctor like some of yall mentioned but its time to file with my insurance in about 2 weeks. And this doctor I have to drive 1 1/2 hrs to get to the rest are around 4 hrs or more. I live in louisiana. I called a few other doctors but really they dont sound any better. lol just great right. My center is a 5 star bariactric center and blah blah blah.. I guess they just expect me to never ask any questions. I call and they hate to return my calls. My doctor is kinda rude.. lol I talked to some other who used my doctor on this site and they say thats just his personallity. So I dont know if they can just file get me approved and have me on my way I will be happy lol :thumbup: