Out of Network/Out of My Mind

[Cate18 0]

I haven't posted in quite some time. Probably because I was so convinced that I would be approved that I was just dancing along not worrying too much about anything. Well what a frustration ! Today I found out that my insurance took several weeks to get to my file, only to tell me that my doctor is out of network and not covered. I took a deep breath when they told me and thought...wait for it...."Duuuuuuuh".

I know he's out of network ! But you geniuses don't have a single lapband doctor IN network. You told me since there was no doctor in network that you would automatically review my file !

I'm trying to stay on the sanity train, but is it ever hard. Now I completely understand all of you that have posted all of your stories about insurance, and I definitely commiserate ! Not trying to be a downer, or a griper, but just typing that made me feel so much better.

Anyone else have something similar happen and have any suggestions ? This seems to be a first for my doctor. Thanks in advance for any suggestions.

[April410 0]

Did the insurance say they would cover the LapBand if the doctor WAS in network? Or are they turning you down whether he is or not?

I wish I could help you but I am fighting the depression of having been turned down by my insurance.

I've spent the past two months going from doctor to doctor, having all the required tests, dieting to lose 5% etc.....only to be told my BMI is not high enough.....so the answer is no.

I feel so upset about this........I was told by the bariatrics office staff that with a BMI of 36.8 (and not the 40 the insurance requires) that I would probably be a good candidate because I have type II diabetes, thyroid disease, GERD, Barretts Esophagus, elevated blood pressure and cholesterol and mild neuropathy (due to the diabetes)..........Wrong!

Now I have to see if I can appeal their decision but right now I am feeling pretty discouraged.

Good luck with yours.

[silvers320 12]

I dont know how long ago you were denied, but NYS has a department of insurance that serves to review cases on a 3rd party independent basis. I was turned down by my insurance company on the first go around. I appealed to the NYS department of insurance and was approved within 35 days. There are rules - I think you had to get the state involued within 90 days of being turned down, but should look into it