Denied, and Looking for Support

[serenity55 15]

I posted this on the insurance thread, but I guess I really want encouragement and support.

I’ve been dealing with insurance for months now. First they told me that I wasn’t elegible to get a lap band because they didn’t have office notes from my doctor. Then it was because they didn’t have a psychological evaluation. Then it was because they didn’t have five years proof that I’d tried other weight loss methods. (Or maybe the weight loss thing was first.)

Anyway, my doctor sent office notes, I wrote a letter explaining why I couldn’t show proof that I’ve been trying to lose weight, not just for five years, but for over twenty. Oh, my insurance company also wanted to send me a very long distance from where I live. I don’t drive, I use public transportation, and I explained that it wouldn’t be good for a post operative patient to travel such a long distance.

So I’ve been denied, and I’m so depressed I just want to crawl in to a hole, or in to bed, and stay there, eating myself to death, because that’s the one way I know I won’t feel anything.

But I am feeling, because I’m upset. I think, Well, maybe I just don’t want the band, but then why the hell am I fighting, and why am I so upset? Answer: Because some part of me does want it.

I will probably feel better tomorrow, and hopefully I’ll find the strength to do what needs to be done. I guess I just need some encouragement, support, or a good talking to?

But be gentle, please?!

Edited October 3, 2008 by serenity55

[BethFromVA 5]

Hey, Serenity, first of all I'm sorry to hear this. I haven't gotten started yet, but so far I hear my insurance covers this. I go to my doc on Tuesday to begin everything, so we'll see what "coverage" means.

Secondly, if your insurance covers this, do NOT give up!! Appeal this! I went to the seminar last night and said out loud that I was alarmed at the amount of money my meds (which I believe are ALL weight-related) cost a month (about $500 to the insurance company) versus this procedure, and the doctor stated that many insurance companies realize they only cover you for a couple years and then policies change, etc. They'd rather put out the cost of meds than something large like this. So, he said, they make many jump through hoops hoping you will give up (for you it is all the outrageous demands, for some it is 6 months of pre-op dieting).

Please do not just take their "NO" lying down. Find out how you can appeal and ask for your doctor's help on this. I know I saw something the other day about this very thing -- how to appeal their decision. Let me look through my computer history and see if I can find it for you.

Good luck, and PLEASE don't give up on your right!

[serenity55 15]

Hey Beth, thank you for the words of encouragement. I know that some insurance companies just don't want to pay for weight loss surgeries; in fact, my best friend was saying that this evening. It really makes me mad, because, like you, I take medication that i'm sure I wouldn't have to, if I lost weight. I might even be able to lose my CPAP machine, which I know cost them a pretty penny. It all adds up.

Thanks again. I needed to read what you had to say.

Debbie

[karen_karen 0]

this is just a thought have you ever looked into a bodybugg? they seem to be a great tool to help lose weight and keep you movtivated. just google the bodybugg usually if you join a gym that has one you can get it for half the price as you just buying it out right its alot cheaper then lapband. also im sorry to hear about your stress with all the insurance stuff i understand that it can be hard and frustrating but keep your head up.

[vsnowrn 0]

I say don't give up!!!!!! Insurance companies are total jerks when it comes to this type of surgery. Thankfully mine was easy, I had a answer in 30 days, and no pre op funny stuff. And get this I work for a temp agency LOL. Anways, have you MD help you and write them a letter stating what you have just told us. That all the medication and CPAP machine in the long run will cost more than the surgery not to mention the upcoming problem with being obese. Be persistent and even pushy, insurance coverage is your right if you pay the premiums and their policy says they cover weight loss surgery. They want to make you jump through all these hoops with hope that you will give up. I have read that some people gained weight just to make the cut off for the insurance to cover their procedure. Think about that one, that crazy obese people gaining weight just so they can qualify for weight loss surgery. WOW I would be bugging the crap out of the insurance company if I were you, I might write a letter a week, and call them everyday. LOL But that just me. Good Luck and keep us posted

Veronica

[serenity55 15]

Thank you both. Karen-Karen, I've never heard of the body bug. Interesting. I'm really intent on making my insurance company pay for the surgery. I spoke to the liaison, or support person that deals with my employer, and she suggested that i have my doctor appeal for me, or call the member number on my insurance card and have them appeal. I've also read about obesity law.com on this site, and am seriously considering applying to them for help. I went on their web site last night and liked what I read.

Veronica, I wish you lived closer to me. You said you'd be calling every day, or writing letters every week. I really think that's how you get things done, and it's not something I'm good at, but i guess I'm learning. that's great that you didn't have any trouble with your insurance company.

anyway, I feel better knowing that I have options--not that I didn't knowthat last night, but I was just so bummed everything seemed hopeless, and i thought, why am i trying so hard?

Debbie

Edited October 3, 2008 by serenity55

[BethFromVA 5]

Serenity, I re-read your original post and I'm confused... does your insurance cover obesity surgery but they are denying you, or do they not cover it? I'm guessing they DO cover but are denying you? Just want to make sure I understand.

[Minxz 0]

Did your PCP refer you to a surgeon? If so his/her staff should be well versed in the appeal process and be willing to help you through this. If your insurance is a no go most offices offer financing of some sort. Don't give up remember most things worth anything take a lot of effort!

[serenity55 15]

Beth, I know it's very confusing. My insurance company has different plans, and the one my employer has chosen makes me start with my primary care doctor. I couldn't even get a referral to a surgeon, but in talking with the support person, I was told that bariatric surgery isn't excluded. I'm confused because most people on this site have been sent to a surgeon, but I can't even get that far, so I've just done what they've told me they needed, the psych eval, the cardiology exam, whatever. I'm not giving up, but it's very frustrating because I feel like I'm not being given the same treatment as most people here seem to get, i.e. going to a surgeon and doing all the pre op testing and nutritional guidance under that person's guidance.

I've made an appointment to see my doctor, but that's not for another week and a half. I have six months to appeal, according to the letter I got yesterday, but I want things to happen now, and I hate waiting for another week. I was also told that the insurance company would appeal for me, too, but it was suggested that I first go to my primary care physician. If I had my way, I'd go to her, the insurance company, and obesity law.

Can you tell that patience isn't a virtue? I'm just going to try to keep searching and learning, as my signature says.

[LoveIslovely 0]

Do not give up! Through struggles come success!!

[BethFromVA 5]

Please forgive me if I'm sounding stupid, but what I got from your post is that your PCP is potentially the hold-up? If you've done all the hoop jumping, then why haven't you been to a surgeon yet (insert rhetorical question here)?? Wow...

[serenity55 15]

I guess because she didn't think she could send me to one without authorization from the insurance company?

[BethFromVA 5]

So at this point do you think it is due to the PCP or the insurance company? Or is it a matter of which came first, the chicken or the egg? lol

Sorry, I don't mean to make light of this, and I'm really not. I'd say if it's your PCP, can you get a new one? If it's the insurance company, can you talk to somebody or appeal? I have been spending hours on here and have found that a lot of successful appeals have gone through. I hope the very best for you.

[serenity55 15]

Yes, I’m definitely going to appeal. I think the fault lies with the insurance company. My doctor told me to be prepared for a fight. I’ve written to obesity law.com to ask if I should let my doctor appeal first or just go with them. I just learned I might only have one chance to do that.

[Michee 2]

Serenity

Good luck with your appeal. Do not give up.

I live in Ontario Canada where the band is considered and therefore not covered by our health insurance. Even after paying 16k for my band, I would do it again even if it meant selling my house.

Do whatever is necessary to get the band, it will be sooooo worth it.