insurance pain...

ok, this is a good one. i'm angry and don't know what else to do. i called the insurance company today and was told i was again denied even though they received the paperwork they wanted from the first denial. this time it is supposidly because the gastric bypass is not a covered benefit and there was not eighteen months of documentation for dieting and least evasive attempts at losing weight. now, the best part is my husband was approved from my same insurance for gastric and is scheduled for testing soon!! the rep did say something about giving a peer to peer telephone number for my doc to call their reviewer/doc to talk over the case. has anyone ever heard of that!? what was the most number of appeals anyone has heard of that someone had to through prior to approval?!! Stacy

Stacy, Hang in there and dont get discouraged. Yes, I have heard of that peer to peer telephone calls and alot of time they work. Do you have any documentation on your weight loss attempts or anything? I would also check on the insurance help message board you may get more advice. Hang in there and Good luck. Bridget

It sounds like you need more documentation regarding your attempts to lose weight. It It sounds like the peer to peer situation would benefit you if your doctor does know your full history with weight loss and dieting and your struggle. I would give that number to your doctor and hopefully your doctor will be able to do it soon. I would guess that your husband has better documentation regarding diet history and/or has more issues but I could be wrong. Something about his history or current situation got him approved. In the meantime you should continue trying to diet and exercise so that you can show them that you are trying, and you might have to do it for awhile longer but not sure. I know that is what my doctor told me before I switched providers. Good luck! Sherry

I would not waste time fighting it yourself, take the few $$ and hire attorney Gary Viscio .... I've been told he's excellent at overcoming denials, and specializes in WLS cases, he's a WLS patient too.... I would fight it HARD, especially since they approved your husband.