They might deny me!!

[Mrsace13 0]

I called my insurance this morning since they said last week it was pending and should be completed soon. I was told it was denied but now pending again and they were waiting to hear back from my doctors office. When I called there they said they were already on it and in touch with my insurance. Later my dr office called and said it looks like they are going to deny me since my BMI is a 38 and they dont think I have enough medical issues. I dont know what more they want from me!! My PC dr wrote on the letter that I have pain with walking and so on.

Dr office said she will give me the information to appeal it. I will appeal it until they approve me, I will not give up on this. I have so much pain from my weight.

I hope to hear something tomorrow. I am going to call first thing and see who will talk to me. I can't get denied, I just cant!!:cursing:

[Brockbabe82 0]

I hope everything works out well for you!:cursing:

[Mrsace13 0]

Does anyone know??

When they did my first weigh in my BMI was between 38-39. My insurance states I have to have a BMI of 40 or 35 or more with medical conditions. Well, after the holiday and of course I am trying not to but I am eating with the mind thought of, I will get it off after surgery, enjoy it now. So I know for a fact my BMI is now 40, I didn't mean to gain weight but I have.

Do they only go by your first weight or do they look at gaining as if you meant to gain weight to get approved? I didn't know if I should bring that up to them or not.

Edited December 4, 2008 by Mrsace13
spelling error

[tashanicole1271 0]

When I started the journey, my BMI was 40.7. I purposely tries not to lose weight on the 6 month supervised diet that my insurance required, in fact, I may have gained a pound or two. If they are denying you, I would say that is is probably because of your BMI. I would go to my PCP and have my new weight recorded for the appeal records.

[Brockbabe82 0]

Does anyone know??

When they did my first weigh in my BMI was between 38-39. My insurance states I have to have a BMI of 40 or 35 or more with medical conditions. Well, after the holiday and of course I am trying not to but I am eating with the mind thought of, I will get it off after surgery, enjoy it now. So I know for a fact my BMI is now 40, I didn't mean to gain weight but I have.

Do they only go by your first weight or do they look at gaining as if you meant to gain weight to get approved? I didn't know if I should bring that up to them or not.

I would be careful because some doctors will NOT do your surgery if you are gaining weight. They want to see that you can make the change, even before the surgery. There are so many medical issues that you could use for your insurance. Rashes from excess weight, high blood pressure, back problems, knee problems, etc.

I am sure everything will work out for you but be careful how much weight you gain, if you are seeing a surgeon.

[Mrsace13 0]

I am really trying not to gain weight but I am so out of the "diet" mode right now. I really have to get on track again until my surgery. I am still pending and still waiting but I will appeal and like you said, there are plenty of conditions. Plus I found out from my insurance that my BMI was a 39.4, please, give me a break!!

The insurance said their doctor was still reviewing it. I do not know much about insurance so I didn't really get that but I will call back on Monday, and Tuesday and each day until I'm done.

[Mrsace13 0]

Denied today

[Brockbabe82 0]

I'm sorry you were denied... Appeal though. I hope everything turns around. :wink_smile:

[Mrsace13 0]

I am so upset. I have been calling the insurance and had a feeling this was going to happen but when I heard the word today, it was really hard to handle.:angry_smile:

I called my dr office right away since they said the letter went out on Friday with the reason. My dr office said they would call first thing tomorrow and call me back with the reason and what we needed to do next. There is NO way they are going to deny me. I have read thier policy up and down and have followed everything they wanted me to do. I will fight this until I win, I can't even hardly walk due to limphademia in my legs and my PC wrote that in the letter, that should be reason enough. I can not live with this pain anymore.

[tashanicole1271 0]

I wonder if the BMI had anything to do with it? These insurance companies are such sticklers about it being at least 40. I have been on the forum so much that I feel like a denial for one of us is a denial for us all! Keep fighting and hang in there.....God bless!

[Mrsace13 0]

They said my BMI was a 39.4, if they need it 40, after the holiday, weigh me now, lol.

I said that to the girl that works with the insurance at my dr office and she said sometimes they still want medical issues with a 40, but I would fight that too, if that is what they want, then they would need to have that in their policy.

I know what you are saying, when I see someone approved or denied, I do feel like a family here and get happy or sad for them too. I get on here at least once a day just to check on people or to see the updated pics.

Thank you and I will update when I know something.:angry_smile:

[SuzanneG 1]

Teresa, you are on the right track with an appeal! I was denied for BMI 35.1. By the time I assembled my appeal package it was 36.7. I wrote 2 letters from me, one medical and one emotional, then I went to all my doctors, GYN, Podiatrist, Gastrointerologisty, PCP, and asked each of them to write me a letter of support, then forwarded that to my bariatric doc who wrote his own letter and sent the package forward and it was approved. The higher BMI helped and the letter inspired the reviewer to call and tell me personally.

I have said this many times on this forum and so far as I know we're batting 1,000, if anyone wants to borrow my letters to use as a template I'm more than happy to share. Just PM me your email address and I'll shoot it right out to you!

Hang in there, you'll get it!

[Mrsace13 0]

I know my dr has spoke to the insurance dr today and I am now waiting on the results. I really don't know what they can talk about. This dr has met me for 10 mins but I guess he knows what he is doing. It would have been better to speak to my PC dr that knows me.

So, I'm just waiting now to find out if I still need to appeal it. This is so stressful. I'm off work today, I wish I was working to keep my mind busy, lol.

[Mrsace13 0]

Just my update

After the peer to peer the other day I was waiting for my dr office to call me, they never did so I couldn't handle the stress anymore and I called my insurance to find out that they said we needed to appeal.

So I have been waiting to hear from my dr office, still haven't so I went ahead and called them. The girl that starts the appeal was out and they will be sending something and contacting me tomorrow. I keep offering to come in and weigh in again. They said my BMI was 39.2, after this stress it will be doubled soon if they don't get this done, lol.

So, again, I'm waiting. I'm trying not to even come on here much. I need to keep my mind busy. The stress of all this is really making me sick, I can't even sleep, I'm not a person that crys much but this is really pushing me there:cry_smile:. I need this so bad and I'm sure I will be approved in the end since I'm not giving up anyway until I am, this waiting game and being told that they do not need me to do anything right now is killing me. I feel like I need to call or write or something!!

Thanks for being there for me just to rant, I'm just sad today.

[SuzanneG 1]

Teresa,

Sorry to hear you are having a rough day. I can relate. It took me 3 months from seminar to approval and it was torture.

Stay after your doctor's office as much as you feel like you can and other than that just try to stay possitive.

Try to enjoy your holidays and plan on starting on the new you in 2009!

Hope you're feeling better today!:smile2: