Seriously angry and depressed

CTerry · August 18, 2008

I just received an e-mail from this discussion forum saying I have not been active on the site for awhile. This is only because I spend 18 months meeting a lot of requirements for my lap band surgery only to be told my insurance company, United Healthcare, they will not cover my procedure because "it hasn't been proven effective for my obesity". I have addressed the issue from the start that when I lost the 10% weight requirement that I would be around a 37 BMI and I wanted to make sure that I would still qualify, and I was assured I would be fine. I have spent close to $1000.00 in insurance co-pays, days off from work, cardiac testing, sleep apnea testing, education classes at the bariatric center and psycological testing only to be denied by insurance and I do not have the money to private pay. Once again, I feel like I have been taken advantage of because I am obese and looking for help. Your forum has been great in answering my questions but I get terribly sad when I am in there and think to myself I could of been one of those success stories if they had just given me a chance. :blush:

Edited August 18, 2008 by CTerry

2BtinyinTN · August 18, 2008

CTerry-I am sorry to hear about your situation but I can totally relate! I had to do the same thing. Loose the 10% and then it put my BMI at 37 or 38 and BC denied me. I gained about 10-15pds back and then they approved me. Go figure! Don't give up all hope yet. I too didn't have anything medically wrong with me except for slight hypertension.

HeatherO · August 18, 2008

Don't lose hope just yet. Have you tried to appeal? Many people have had an initial denial and were able to get it to pass by filing an appeal. This is especially true if you have taken all the steps required in the beginning.

I hate to say this, but maybe a couple more pounds may put you over so that you can be approved. Definitely try the appeal route first. Perhaps your doctor can also help you out with a letter or a phone call to bolster your case.

Another thought is to maybe post another thread (or even a poll) regarding those who have had an initial insurance denial, reasons for denial, appeal success, etc.

You may still be able to make this happen if you are diligent. Good luck.

aubrie · August 18, 2008

APPEAL!!!! It took me 11 months to get approval. DON"T give up. I had to get letters of support from my OB/GYN, rhuemetologist, my PCP, and my cardiologist before they decided to pay for it, not to mention the hoops I danced through like you did. Just be persistant. The insurance companies are counting on the fact that you will give up. I think they just want to see how bad YOU want it...... bastards...., but play the game. You'll win in the end.

charliegirl · August 18, 2008

I just received an e-mail from this discussion forum saying I have not been active on the site for awhile. This is only because I spend 18 months meeting a lot of requirements for my lap band surgery only to be told my insurance company, United Healthcare, they will not cover my procedure because "it hasn't been proven effective for my obesity". I have addressed the issue from the start that when I lost the 10% weight requirement that I would be around a 37 BMI and I wanted to make sure that I would still qualify, and I was assured I would be fine. I have spent close to $1000.00 in insurance co-pays, days off from work, cardiac testing, sleep apnea testing, education classes at the bariatric center and psycological testing only to be denied by insurance and I do not have the money to private pay. Once again, I feel like I have been taken advantage of because I am obese and looking for help. Your forum has been great in answering my questions but I get terribly sad when I am in there and think to myself I could of been one of those success stories if they had just given me a chance. :wink2:

Please dont be down, I am suffering a set back in my Quest for banding in the UK.....I know how you feel, although I have not had to spend any money for this as wanting it on the national health service. I do understand your frustrations though. Please dont feel alone, there are others in the same boat....Linda x

annabella · August 18, 2008

CTerry, Aubrie said it right. They are hoping like HELL you'll give up. Most people do. They take their word and go away, they count on this happening. APPEAL till your purple in the face. Call them every day. You've heard the saying, "the squeaky wheel gets the oil". Get all your dr's to send them faxes and letters by mail at least once every 2 wks. Bombard them with info and your voice and your appeals. Your in the insurance game, you have to play to win. GOOD LUCK.

April410 · August 18, 2008

CTerry.......I feel your pain!

I just went through 2 months of doctors' appointments (some weeks I had 2 or 3), tests, psyche evaluation, diet to lose 5% etc.....only to be turned down by insurance.

My BMI does not meet the 40 they require......BUT.....I was told that a BMI of 35+ with at least one co-morbidity would qualify me.....Well, they said no anyway!

I have type II diabetes, thyroid disease, mild sleep apnea, mild neuropathy (from diabetes) GERD, Barretts Esophagus (pre-cancer), small hiatal hernia, high cholesterol and high blood pressure.......... I am also post menopausal.

Insurance company seems to think my medical issues are not that severe.

All of these health issues have contibuted to weight gain and they also contribute to an inability to maintain any weight loss. My endocrinologist basically said that it would take me TWICE as long to lose HALF as much as a "normal" person........

There is no justice in this world.

I too just want a chance. I have spent the past week feeling depressed, angry, hopeless etc........but you can be sure that I WILL fight back! Unfortunately, I am a stress eater so of course the day the denial letter arrived, I went on a junk food frenzy.....

Seems stupid to hurt myself because I am angry with them!

Good luck to you. Let's keep on fighting for our rights.

SueAZ · August 19, 2008

I was at a seminar when somebody asked that question of the doctor. He said that the only weight they put down is the one you started with. He said that why should anyone be punished for following requirements or requests of the doctor or health plan. Now that makes sense. I had a BMI of 36 with high blood pressure and a cardiologist who wrote that surgery would probably solve my problem. I agree appeal the denial.