Insurance denial!

[pigletmik 0]

I guess i just need some advice on what to do next, or just to vent to people who have been where I am now. My insurance denied my wanting the lap band. I am 29, my bmi is 38.5, I'm 5'6", and weight 238, so I'm borderline. I'm as healthy as could be, which is why they are dening me. Don't get me wrong i'm glad I'm heathly, I'm just overweight, and sick of it. I was insulan resistant 3 years ago, but went away when I had my last child, so I'm ok on that part. The only thing wrong with me right now is I'm on Wellbutrin for depression. I have a family history with high blood preasure, high cholesteral, heart attacks, back problems. Both my parents are over weight, and thats how i came to know about the lap band. My mom was thinking about getting it done, but is scared because she has never had surgery before. I've got atleast 7 years documented Dr. notes of trying to lose weight, which I did 4 years or so ago, with the help of Phentamine, I lost 50lbs. The problem was as soon as i went off of it i gained 30lbs back, so I don't want to do diet pills anymore. I've tried different diet pills, Weight Watchers last year, for 6 months, and only lost 6lbs. My best friend did it with me and lost 40! I've done the Atkins diet, the south beach diet, watch my calories and who knows what else. I married into a hunting family, so we hike around the mountains for 2 weeks hunting for elk, I'm a very active person. I've been overweight for as long as I can remember, and for the last 10 or so years, have been trying to lose weight, I'm just over it. I don't know what to do next, I don't want to end up like my parents, and grow older and not be able to do the things I love. I don't want to miss out on playing with my children cause i can't breath and keep up. I just don't care, I guess. I need some words of advice or something to bring my spirit up or something. I don't get what i'm doing wrong. :smile2:

[Mrs. Bubba 0]

Maybe your doctor needs to re-apply to the insurance and use some more convincing language so they can see the whole picture. What you just wrote here makes good sense to me, but I'm not in the insurance business.. Good Luck... Julie

[Donna Makowski 0]

Welcome to the wonderful world of "insurance".....most insurance companies will deny you the first time (READ: automatically deny) - it is in their best interest to do so. If you give up and don't pursue it, they don't have to pay anything. So start fighting!

My insurance company wouldn't even let me ask - they won't cover ANY surgical procedure for weight loss - no matter what. AND....I went to THEIR hospital and surgeon to have it done. Go figure!!!

[tomatogirl 0]

Fight, baby. It's worth it.

[Donna Makowski 0]

AMEN to that!! I'd do it again in a heartbeat!

[pigletmik 0]

Just a quick note, I did write a letter to my insurance explaining how if i don't get this done I'm gonna be having major health issues in the next year or two. And that this is my last resort, I don't have anything else to look forward to except getting sicker! I just hope they approve this time, if not I'm stuck!

[AshleyRN 0]

I just found out today that I am denied by my insurance company as well. It sucks so bad! This was my last resort. Like you, and I'm sure almost everyone on here, I've done almost every diet under the sun and don't get anywhere. I plateau, which is what I'm doing now. I don't know the reasoning for my denial yet, but I'm definitely going to find! We deserve this and I think you need to fight back as well! Good luck and try to keep your head up!

[MiniBand 0]

I was also denied but I am trying to get help with my appeal through an advocacy program I read about on here. Obesitylaw.com So far they are looking at my stuff. I was denied because I didn't show enough proof of multidisciplinary approach. I tried but my Dr. notes are not very descriptive and the behavior modification was done with a registered dietitiandiabetes educator that is available to us at work. I am hoping that it will be before the end of the year! Everyone keep their chin up ok!!!!

[oyesican 0]

Hang in there. I'm fighting mine too. Aetna denied me but obesitylaw.com is working on my appeal so I'm hoping I will be approved and have a good start to my New Year.

[Maggies 0]

I everyone, as you can see I was just banded this past Wednesday. I was also denied the first time. I have a bmi of 41 and need to lose over 100lbs. My surgeon, called the insurance company and turns out they did not have a copy of my sleep study which showed I have sleep apnea. So the surgeons office resubmitted the paperwork to ins. and I was appoved two weeks later. So keep trying, it is worth it. Although I'm still a little sore and gassy, I haven't regretted it. Maggies:shades_smile: